## FINDINGS

Assessment of subtle cartilage, ligament, and tendon abnormalities is limited by the sampled images.

**Bones and cartilage:** Mild focal articular/subchondral irregularity at the medial tibiotalar articulation, including the posteromedial tibial plafond, with small subchondral cyst-like foci and mild reactive marrow signal. Associated cartilage loss is not reliably graded. No definite discrete talar-dome osteochondral defect or displaced fragment. Mild anterior tibial lip and dorsal talar neck spurring/remodeling, potentially partly postoperative. Small reactive marrow/cyst-like focus in the anterosuperior calcaneus beneath the sinus tarsi, with possible mild adjacent subtalar articular irregularity. No acute fracture or osseous collapse. Alignment is maintained.

**Joints and capsule:** Small tibiotalar effusion. Mild anterior and anterolateral capsular thickening/scarring. Small posterior subtalar effusion, with ill-defined fluid-sensitive signal in the sinus tarsi/tarsal canal. No definite discrete ganglion or coalition.

**Ligaments:** Irregular, poorly delineated ATFL with adjacent capsuloligamentous scarring, favoring chronic sprain-related change. A partial tear cannot be excluded; no definite complete discontinuity is demonstrated. Possible mild chronic deep deltoid remodeling. No gross syndesmotic disruption. The CFL is incompletely assessed.

**Tendons:** Small amount of distal tibialis anterior tendon-sheath fluid, possibly reflecting mild tenosynovitis. No definite tear of the Achilles, extensor, medial flexor, or peroneal tendons.

**Plantar fascia and soft tissues:** Plantar fascia is not appreciably thickened. Mild edema-like signal in Kager fat pad without an organized collection. Prominent serpiginous plantar-medial vascular structures of uncertain clinical significance.

## IMPRESSION

1. **Mild focal medial tibiotalar chondral/subchondral degenerative change**, including the posteromedial tibial plafond, with small cyst-like foci and mild reactive marrow signal. No definite discrete talar-dome osteochondral defect or displaced fragment. **Moderate confidence.**
2. **Mild anterior ankle osseous remodeling and anterior/anterolateral capsuloligamentous scarring**, potentially post-traumatic and postoperative. These findings may contribute to anterior impingement in the appropriate clinical setting, but do not establish it. **Moderate confidence.**
3. **Probable chronic ATFL sprain-related change.** Partial tearing is not excluded; no definite complete tear. **Moderate confidence.**
4. **Small tibiotalar and subtalar effusions**, with nonspecific sinus tarsi/tarsal canal inflammatory signal and mild reactive change in the adjacent anterosuperior calcaneus. **High confidence for tibiotalar fluid; moderate confidence for the remaining findings.**
5. Possible mild distal tibialis anterior tenosynovitis. No definite tendon tear. **Moderate confidence.**