A 52-year-old man was admitted to hospital, complaining of foot pain and swelling for approximately 10 days that had gradually worsened. A low-grade fever was also present and he complained of increasing fatigue.
On physical examination, the extremity was noted to be swollen from just below the level of the knee, associated with erythema and induration. The patient denied having any underlying medical conditions. A series of radiographs of the foot and ankle (Figs. 1 to 3) showed obvious marked soft-tissue swelling with evidence of fracture and collapse of the anterior aspect of the talus and the adjacent tarsals. Subluxation of the joints of the tarsus accompanied these findings. Careful examination demonstrated numerous small bone fragments (Fig. 3, arrows).
What diagnoses would you consider?
For the answer and discussion see page 190.
Footnotes
Section Editor: Peter L. Munk, MD
Inquiries about this section should be directed to Dr. Peter L. Munk, Professor, Department of Radiology, Vancouver General Hospital, Vancouver Hospital and Health Sciences Centre, 855 West 12th Ave., Vancouver BC V5Z 1M9.