## FINDINGS

**Limitations:** Interpretation is based on sampled images from the supplied sequences. Small cartilage defects, osteochondral lesion extent/stability, and individual ligament integrity are incompletely assessed.

**Bones and cartilage:** Irregular narrowing of the medial middle talocalcaneal facet near the sustentaculum tali, with indistinct opposing cortical margins, subchondral low-T1 signal and mild remodeling. Intermediate-signal tissue is present at the interface, with adjacent anterior/superior calcaneal marrow edema. No definite osseous bridging.

Focal articular–subchondral irregularity and small cyst-like/reactive signal changes at the medial tibiotalar articulation, involving the medial talar shoulder and possibly the opposing tibial surface. These are better suggested on sagittal and axial images; a discrete talar dome osteochondral defect is not confirmed on the coronal images. No displaced osteochondral fragment or articular collapse.

Mild anterior tibial plafond and dorsal talar neck spurring. Chronic contour irregularity of the distal fibular tip with a possible small adjacent corticated avulsion ossicle. No acute fracture.

**Joints and sinus tarsi:** Small tibiotalar and subtalar effusions. Increased fluid-sensitive signal in the sinus tarsi, partly lobulated, potentially reflecting edema and localized cystic change.

**Ligaments:** ATFL is indistinct with irregular tissue in its expected course, possibly reflecting chronic post-sprain attenuation/scarring. No definite complete tear. No gross acute syndesmotic or deltoid disruption; detailed ligament assessment, including the calcaneofibular ligament, is limited.

**Tendons:** Visualized tendons are continuous without a definite tear. Fluid distends the posterior flexor hallucis longus tendon sheath, most apparent sagittally, potentially communicating with the ankle effusion. Achilles tendon is unremarkable.

**Plantar fascia and soft tissues:** No convincing proximal plantar fascial abnormality. Mild dorsolateral midfoot subcutaneous edema. No organized collection.

## IMPRESSION

1. **Suspected nonosseous middle-facet talocalcaneal coalition**, with adjacent reactive calcaneal marrow edema and localized degenerative remodeling. Focal subtalar arthropathy remains an alternative. **Moderate confidence.**
2. **Focal chronic osteochondral/subchondral abnormality at the medial tibiotalar articulation.** A discrete medial talar dome osteochondral lesion is not definitively established; cartilage integrity and lesion stability cannot be determined from the sampled images. **Moderate confidence.**
3. Possible chronic ATFL post-sprain scarring/attenuation and small chronic distal fibular avulsion ossicle. No established complete ligament tear. **Low–moderate confidence.**
4. Small ankle and subtalar effusions with sinus tarsi edema/possible localized cystic change. Posterior FHL sheath fluid may be joint-related; associated tenosynovitis is not established. **High confidence for the ankle effusion; moderate confidence for the remaining findings.**