Case 3

This is an MRI foot and ankle study showing abnormal low T1 and high T2 and PD signal intensity in the bone marrow of the body and head of the talus bone and medial aspect of the navicular bone, and 4^th metatarsal head and shaft – these findings represent bone marrow oedema. There is no evidence of bony erosion, and no joint effusions.

I note that there is fluid around a prominent posterior talar process, which may indicate posterior impingement. I also note a small calcaneal plantar spur.

In the correct clinical context, the findings would suggest bone marrow oedema syndrome of the foot and ankle. The differential diagnosis includes stress fractures, ischaemic injury and osteomyelitis.

I would ask about a history of trauma – or lack thereof which would support this diagnosis. I would obtain gadolinium enhanced series – lack of synovial enhancement would be expected.

I would then flag this case for discussion at orthopaedic MDT.