52M had previous work related injury and distal achilles debridement and
reimplantation sometime prior to our earliest exam 5 years ago.
Had surgery 3 years ago, which appears to have been FHL transfer.
I read the forefoot today, realized that ankle MRI was done 2 weeks ago.
[image: 1.jpg]
There is acute denervation edema without atrophy of the Abductor Digiti
Minimi in the forefoot.
[image: 2.jpg]
[image: 3.jpg]
The ankle MRI shows selected fatty atrophy of the superior central portion
of the ADM in the hindfoot.
[image: 4.jpg]
This is to illustrate the surgical changes of the distal Achilles and FHL
transfer
[image: 5.jpg]
There is mild perifascial edema at the lateral origin of the lateral cord.
There is a large enthesophyte of the plantar medial tubercle.
[image: 6.jpg]
Is there some scarring around the tibial nerve with minimal bright
fascicular signal?
[image: 7.jpg]
[image: 8.jpg]
[image: 9.jpg]
I’ve tried to find some detailed bundle anatomy of the ADM, but couldn’t.
I’m surprised that there is differential atrophy and edema of the ADM in
the hind and forefoot, and am confused by the segmental chronic atrophy in
the hindfoot.
Since the prescription said (foot pain) I don’t know if it corresponds to
the ADM in the forefoot, but I find nothing else of note.
Unfortunately, the prior pre-Revision Achilles MRI was done in an open 0.3T.
Please explain what is going on here with the ADM.
Thanks.
52M-chr-foot-pain-FHL-transfer-3-yrs-Ach-surg-before-that.pdf
