osteonecrosis ( RID5180 )
This woman initially presented 13 months ago (1st 3 slides) with acute onset severe lateral 1st submet pain superimposed on mild chronic pain. Though she had AVN of the fibular sesamoid (white arrows), there was no articular collapse, and the marked reactive edema was related to a focus of HADD (yellow arrows) in the lateral head Flexor Hallucis brevis, acounting for her acute symptoms. The patient returned yesterday (last 2 slides): the acute, severe pain resolved long ago, but she has had chronic pain with recent worsening. Now the necrotic fibular sesamoid is fragmenting and there is enhancing synovitis around a small fragment (thin white arrow). The DPM is planning sesamoidectomy.

Rate Case : GoodGreatExcellentWOW !!!