Medical Imaging Analysis Report

I. Imaging Findings

Based on the provided X-ray images of the right ankle, there is a localized irregular bony overgrowth in the medial aspect of the ankle joint (involving the talus or adjacent tarsal bones). It appears as an exostosis-like lesion, showing a relatively distinct bony protrusion with clear boundaries, with possible calcification visible, and continuity with the adjacent normal bone. Overall, the proliferative site is continuous with the epiphysis (or articular surface), and may show a cartilage cap-like structure.

No clear fracture lines or obvious destructive changes were observed. Soft tissue swelling is relatively mild, presenting as a protruding mass. There is no obvious sign of trabecular disruption.

II. Possible Diagnoses

Considering the patient is a 14-year-old male with a 6-month history of a floating, non-painful ankle mass, and correlating with imaging findings, the following diagnoses should be considered:

1. Trevor disease (Dysplasia Epiphysealis Hemimelica): Also known as hemimelic epiphyseal dysplasia. It commonly occurs in children, often affecting the ankle or knee joints, characterized by unilateral epiphyseal overgrowth. Imaging typically shows ectopic bony proliferation connected to the epiphysis, with a characteristic cartilage cap.
2. Chondroblastoma: Commonly seen in the epiphyseal region during the growth period, generally presenting as a cystic, lucent lesion with a possible sclerotic rim. It often involves painful symptoms.
3. Osteochondroma: Resembles an exostosis, commonly seen in the metaphysis, featuring a cartilage cap. However, it more frequently arises from the metaphyseal region of long bones and usually has less impact on the articular surface.
4. Enchondroma: Typically an intraosseous lesion with a lucent appearance, often found in the small tubular bones or medial aspects. Most cases do not show a pronounced protrusion on the joint surface.

III. Most Likely Final Diagnosis

Combining the patient’s age, clinical presentation (painless swelling), lesion location (unilateral epiphyseal overgrowth in the joint), and imaging features (continuous with the articular surface, cartilage cap-like changes), the most fitting diagnosis is Trevor disease (Dysplasia Epiphysealis Hemimelica). For further confirmation, an MRI could be considered to precisely visualize the cartilage cap and delineation from normal epiphysis, or a biopsy could be performed if necessary to exclude other uncommon lesions.

IV. Treatment and Rehabilitation Plan

For Trevor disease, the treatment focuses on correcting or reducing functional impairment caused by abnormal epiphyseal growth, alleviating pain, and preventing secondary joint damage. Specific considerations include:

1. Conservative Management: If the lesion does not significantly affect joint function and there is no pain or other associated symptoms, periodic follow-up and joint protection (e.g., bracing, limiting high-impact activities) can be used to monitor disease progression.
2. Surgical Treatment: In cases of marked local overgrowth leading to limited joint mobility or deformity, surgical excision may be performed before epiphyseal closure. Joint surface or bone shape correction may be necessary to prevent osteoarthritic changes.

Rehabilitation/Exercise Prescription Recommendations

Following treatment or during conservative management, appropriate rehabilitation exercises help maintain joint mobility, muscle strength, and function. Adhering to the FITT-VP principle:

• Frequency: Start with about three sessions per week, gradually increasing to four or five as tolerated.
• Intensity: Begin with low-impact or non-weight-bearing exercises (e.g., straight leg raises, seated ankle movements, light resistance band training), avoiding excessive weight-bearing or high-stress actions on the joint. Gradually increase resistance or moderate weight-bearing.
• Time: Start with 15-20 minutes per session, progressively increasing to around 30 minutes, depending on the child’s tolerance.
• Type: Consider stretching, resistance band exercises, swimming, or stationary cycling with the ankle supported as low-impact options. After recovery, gradually introduce active range-of-motion exercises for the ankle.
• Progression: Increase exercise volume and difficulty in a stepwise manner as the child adapts, while closely monitoring for ankle pain or swelling. Adjust the program as needed.

During rehabilitation, closely observe joint response. Suspend activities and seek advice from an orthopedic specialist or rehabilitation therapist if significant pain, discomfort, or local swelling occurs.

V. Disclaimer

This report is based solely on the available clinical and imaging data, serving as a reference for analysis. It cannot replace in-person consultations or professional medical advice. If any doubts arise or symptoms worsen, please seek prompt evaluation and treatment from a qualified hospital.