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NurseElisa, LPN
Category: Health
Satisfied Customers: 666
Experience:  30 years, critical care, home care, management, coronary care, gastroenterology, sex!
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I have had an MRI and I need som explanations aboput the ...

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I have had an MRI and I need som explanations aboput the report. Can someone help me?
Absolutely. Type in the whole report and let us know why you had the MRI. Thanks.
Customer: replied 9 years ago.
Study:MRI Foot w/o (Left)#####-##### XXXXX MRI ankle (Left) Clinical history:Foot pain,Trauma LT foot,Posterior Tibula Plantar Insertion,HX OF NEUROMA>      MRI of the left hindfoot and ankle. procedure: routine MR imaging of the left hindfoot an ankle performed without intaarticular or intravenous contrast.             FINDINGS: OSSEOUS STRUCTURES/ARTICULAR CARTILAGE; There is reactive marrow edemia involving the plantar spur of the calcaneous secendary to high grade partial thickness tear of the medial cord of the orgin of the plantar fascia. Marrow signal intensity is otherwise normal. There is no fracture or dislocation. There is no osteochondral defect or significant degenerative joint disease. There is a tiny type 1 accessory navicular bone.      I had the MRI because I hurt my foot on SEPT. 30 and I knew something was wrong.
You can hit the CHAT button on the front and I can be called.
Okay - here I am.

You must have had a neuroma in your foot at one time - your doctor wrote that you have a history of a neuroma. A Morton's neuroma is not actually a tumor, but a thickening of the tissue that surrounds the digital nerve leading to the toes. I don't see this on the MRI, so you must have had that removed. You have reactive marrow edema because of the trauma that was caused when you ripped the medial cord from the plantar fascia.

If you look at the picture below, you can see how the tendon are connected to the calcaneous (heel bone) - this is called the plantar fascia tendon - you have a high grade partial thickness tear in the medial one - the one closest to the instep.


You also have a tiny accessory navicular bone. This is also located up further, by the side and before the beginning of the big toe. Having an extra bone here is not unusual (about 50% of all people have this). This may or may not be giving you a problem too, but it was picked up on the MRI. It doesn't show any "signals" which would mean there is swelling or edema. Look at the picture below:


Other than the tear in your heel area, which is quite significant because there is marrow edema (indicating the trauma of the tendon pulling from the bone), you have no arthritic degenerative findings, which is a very good sign.

You didn't say what the doctor suggests in fixing this problem. Usually they like to fix the tear so that you can have mobility again. I hope you are elevating your foot above your heart up on pillows as much as possible, including when you are sleeping, so that you bring down as much swelling as possible. Actually, I don't see any evidence of soft tissue swelling in the MRI, but the MRI is most appropriate in picking up fractures, spaces between the bones, cartilage, ligaments and tendons.

If you have any questions, please let me know.
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Customer: replied 9 years ago.
Relist: I still need help.
I need to continue to get answers from Nurse Elsia. I sent her probably only 5% of my MRI I Need to send the whole thing. Should I do this at on time? I can't pay $15.00 for each responce just one at a time. I am very concerned about the hope that I will be able to dance again! I have hurt greatly in the past years from depression and I have never been able to find a hobby that I enjoyed until I discovered Irish Step Dancing!!! I began to hurt in August 2006 in the ball of my left foot, I went to the podiastris (foot doctor) and she said that I had Hooters Neuroma? ??I guess she knows. I did not dance until Sept. 30 th . She said at that time I could start back. I was dancing for my family on sat. when this happened ( I must tell you ,I forgot to stretch ) .it happened all of a sudden and it felt like someone hit me with a baseball bat. If I am patient and do what the doctor tells me will this heal so I can dance again? I want to send you all of the information in the report.Can you send the answers to an additional e-mail? If you can please send all, even the ones you have allready sent [email protected] Please send me instructions as to how to start.By the way my name isXXXXX only want Nurse Elsia to Respond
I am here. Send the rest of the MRI in this response.
Customer: replied 9 years ago.
LIGAMENTS; There is high grade partial thickness tear of the oriain of the tibial/medial cord of theplantar facia. The tear measures 2.3 cm long axis and involves the full width of the medial cord measuring 15mm transverse with high grade, approaching full thickness tear. the lateral/fibular cord is in tatact. Ther is moderatr reactive plantar fascitis.THIS IS ONLY THE SECOND PARAGRAPH OF MANY. wILL YOU BE ABLE TO SEND ALL OF OUR CONVERSATION TO THE OTHER E-MAIL i MENTIONED? Can I pay at the end of our talk? I see that there is only 3 of 4 answers been accepted. I don,t remember rejecting an aswer.
Keep putting it here. It's cheaper. It sounds like full width of the medial cord is involved - which means it goes from one side of to the other of that tendon I showed you on the heal - the plantar fascia - this is going from the inside of your ankle over to the outside. This is almost torn all the way through.

The lateral cord, which runs along the other side by the pinky toe is okay.

Keep writing.

Customer: replied 9 years ago.
The distal tibiofibular syndesmosis, anterior and posterior inferior tibiofibular ligaments, anterior and posterior talofibular ligaments, calcaneofibular ligament, deltoid ligamentous complex, plantar calcaneocuboid, plantar calcaneonavicular, long plantar ligament and subtalar ligaments are intact..
That's good. All good things here. Keep going.
Customer: replied 9 years ago.
Reply to NurseElisa's Post: Do you have an answer about sending all of this talk to me on the other e-mail so I can print the answers for later reference?                                                                                  &nbs p;            Next paragraph------Tendons: The Achilles tendon is intact displaying normal size, contour, and signal intensity. Anterior and posterior tibial tendons, flexor and extensor hallucis longus tendons, flexor and extensor digitorum longus tendons are intact displaying normal size, contour, and signal intensity. There is type 1 central intersititial partial thickness tear of the peroneous iongus tendon from alevel 12mm proximal to the tibiotalar joint to the level of the peroneal tubecle of the calcaneus. The tear is low grade with mild enlargement and mild central increased T2 signal of the peroneous longus tendon. Peroneus brevis is intact. There is mild perineous tenosynovitis. Fluid is noted about the flexor hallucis longus tendon at the level of the posterior talus and distally at the level of the sustentaculum tali and at the level of the distal cuboid bone. There is mild peroneus tenosynovitis distal to the cuboid.
You are going to have to print all of the answers on the other links because I have no way of combining questions and answers into one link.

So you have another tear in the peroneous longus tendon which doesn't go all the way through the tendon as well. I have a picture of the peroneous longus muscle below - the tendon is the thinner, lower part of the muscle and you can see how it is attached to the foot. You have mild tenosynovitis (increase of the synovial fluid of the tendon, which is expected with your injury) and fluid noted around the flexor hallucis longus tendon, which is located at the bottom of the foot (see diagram below for that as well). This fluid would be expected with your injuries. And the other tendosynovitis is increased synovial fluid as well, which is expected too.

graphicThe peroneous longus tendon is the part in the circle. You can see how this attaches to the muscle in the larger picture. This tendon is on the side where your little toe is. You can see how it meets up with the tibial bone in the little circle where the little red spot is.

graphicThe orange part is the flexor hallucis longus tendon where fluid was found around. This would be normal as it isn't listed as being damaged, but fluid from swelling would go to the lowest point in your foot, so this okay. The yellow part is the Achille's tendon, which has not been mentioned as damaged.

You are sure getting an anatomy lesson tonight!
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Customer: replied 9 years ago.
JOINT SPACE/EXTRAARTICULAR SOFT TISSUE;There is a small ganglion cyst along the lateral aspect of the distal talar neck measuring 12mm x6mmx12mm. There is a 5mm ganglion cyst along the medial posterior border of the subtalar joint. There is a small retrocalcaneal bursal fluid collection likley representing mild bursitis.IMPRESSIONS:1. HIGH GRADE PARTIAL THICKNESS TEAR INVOLVING THE MEDIAL CORD OF THE ORIGION OF THE PLANTAR FASCIA.2. SUBTLE TYPE 1 PARTIAL THICKNESS CENTRAL INTERSTITAL TEAR OF THE PERONEUS LONGUS TENDON.3. PERONEUS LONGUS AND FLEXOR HALLUCIS LONGUS TENOSYNOVITIS AS DESCRIBED ABOVE.This concludes the report on the hind foot and the ankle. There is an entire other report on the forefront of my foot. Do you have an opinion as to what I should do? Will this heal on its own? Do you think that I will be able to dance again? Do you think that I should have surgery? A lot of questions but I want to do the best thing for my foot. I clicked on need information but I will click on accept ASAP.
So on top of all this, you have two ganglion cysts.

You didn't say what the doctor said about this.

It sounds like the first one we talked about (the medial cord) will have to be surgically corrected, as it is almost a full thickness tear and has the most amount of damage. The doctor may leave the navicular bone alone if it is not bothering you. I didn't see anything about a neuroma on here, but they may have been part of the last part where we talked about the flexor hallucis longus tendon where the there was fluid build up, which was find. There appeared not to be any evidence of a neuroma (interesting). You have a less traumatic tear in the the peroneous longus tendon, tenosynovitis which is the inflammation of the synovial sacs with fluid which is not unusual for this trauma, two small ganglion cysts and a navicular bone.

This is what I would do: see your doctor and get his opinion. Make sure you get a copy of the MRI films, as doctors like to look at the actual MRI images themselves. After the doctor has made his/her recommendations, I would see a second doctor, not say anything about what the first doctor said (and make sure they aren't practicing together) and tell him/her you want his/her opinion as to treatment. To me, it sounds like you will need surgical intervention.

As far as getting back to dancing, It all depends on the surgery, how you heal and how you do with your exercises. The faster you heal and go through rehab without problems, with all the swelling going down and good stretching ability, the doctor will be better able to determine if you can go back to step-dancing. It is totally premature to even discuss this right now. I know you love it, but you have to take tiny steps to get to that point.

If you have any further questions, please let me know.
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Customer: replied 9 years ago.
Do you need me to give you the other half of the MRI results? I could send it all at the same time. How much longer are you avaliable for questions?
There's MORE???

I'm here for another hour or so.
Customer: replied 9 years ago.
THERE'S the Morton's neuroma.

Healing marginal erosion of the head of the 1st metatarsal space, and superimposed osteoarthrosis are degenerative changes and will not go away. Hopefully it won't get worse though. However, if that Morton's Neuroma is bothering you, it can be excised. That may calcify and become harder, causing more pain.

Time isn't short, so don't worry about that. I just want you to understand what is going on and let you feel comfortable with all this information. That's the most important part. I'll be back on in an hour and I'll be on tomorrow for part of the day.

I have to go out for an hour, but I'll be back. You can post all the questions you want, because you sound like a great guy and we'd probably make good neighbors!

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