Imaging Analysis Report

I. Imaging Findings

Based on the provided anteroposterior and lateral foot X-ray, CT, and MRI images, the right navicular bone exhibits the following primary changes:

• X-ray: On the AP and lateral views, the navicular bone is abnormally shaped, appearing “comma-shaped” or wedge-like. There is lateral collapse and areas of sclerosis (increased bone density). The navicular margins are irregular, and partial local fragmentation may be noted.
• CT: Further confirms the navicular deformation and fragmentation, clearly demonstrating small bony fragments, disorganized trabecular structure, and the extent of lateral collapse. Localized areas of bone sclerosis are also present.
• MRI: T1-weighted images show generally reduced signal in the navicular; T2/STIR or PD-fs sequences reveal significant bone marrow edema, suggesting local inflammatory reaction or edema. A small amount of fluid may be present around the navicular or in the joint space. No obvious soft tissue swelling or other fracture signs are seen.

Additionally, there is a mild collapse of the foot arch, indicating that structural changes in the navicular have affected the load-bearing mechanism of the foot. No significant severe disease is noted in the ankle or nearby joints.

II. Potential Diagnoses

Considering the patient’s age (59-year-old male), clinical presentation (medial foot pain with arch collapse), and imaging features, the following potential diagnoses are suggested:

• 1. Müller-Weiss Syndrome (Spontaneous Adult Navicular Osteonecrosis)
  Typically manifests as medial foot pain, wedge-shaped or “comma-shaped” deformity of the navicular, disorganized trabecular structure, and sclerosis. Commonly seen in adults, especially middle-aged and older individuals.
• 2. Neuropathic Arthropathy (Charcot Joint)
  Patients usually have a history of diabetes or other neuropathies; joint destruction and deformity are more pronounced, often accompanied by soft tissue swelling or other structural damage of the foot.
• 3. Gout or Other Inflammatory Arthritic Conditions
  Can lead to local pain and structural changes, but typically display tophi or erosive lesions around joint surfaces or soft tissues. Patients often have a history of acute gout attacks or elevated inflammatory markers.
• 4. Post-Traumatic Navicular Nonunion or Avascular Necrosis
  A past history of trauma or fracture should be ruled out, but in this case, no significant trauma history is reported, making this relatively unlikely.

III. Final Diagnosis

In summary, taking into consideration the patient’s age (59-year-old male), presence of flatfoot or arch collapse, abnormal navicular morphology (wedge/comma-shaped changes), lateral collapse, bone sclerosis, and MRI findings of bone marrow edema, the most consistent diagnosis is Müller-Weiss Syndrome (spontaneous adult navicular osteonecrosis).

If there is clinical concern regarding concomitant systemic diseases (such as endocrine disorders, malnutrition, etc.), additional tests such as relevant blood markers, pathology, or nuclear medicine imaging (bone scan) may be performed to confirm the diagnosis.

IV. Treatment Plan and Rehabilitation

• 1. Conservative Treatment
  Prioritize non-weight-bearing or reduced weight-bearing measures, possibly using a cast or adjustable brace to limit load. Oral anti-inflammatory and analgesic medications (e.g., NSAIDs) can help alleviate pain and inflammation. In cases of severe pain, appropriate adjustments with analgesics or anti-inflammatory drugs under specialist guidance can be considered.
• 2. Orthotic Devices and Rehabilitation Training
  Utilize arch-supporting insoles and functional orthoses to reduce stress on the navicular. Physical therapy may include heat, ultrasound, and low-frequency electrical stimulation to promote local circulation and soft tissue healing.
• 3. Surgical Indications
  If there is no significant improvement after 3–6 months of conservative treatment and the patient continues to experience persistent pain and functional impairment, surgical options should be evaluated. Possibilities include joint fusion, bone grafting, or correction of foot deformities. The specific procedure depends on imaging-based classification and foot alignment considerations.
• 4. Rehabilitation Exercise Prescription (FITT-VP Principle):
  • Frequency: Initially 3–4 times per week; once pain improves, frequency can be increased to 5 times per week.
  • Intensity: Begin with a pain-free or slightly uncomfortable level; avoid high loads and prolonged standing or walking. Start with non-weight-bearing exercises (e.g., seated isometric contractions of the lower leg and ankle) and gradually transition to partial weight-bearing activities.
  • Time: Start with 10–15 minutes each session; as tolerance increases, extend to 20–30 minutes, adjusting according to pain and response.
  • Type: Gentle ankle joint active movements, foot muscle strengthening exercises (such as exercises with resistance bands, Achilles tendon and plantar fascia stretches), and low-impact aerobic activities (e.g., stationary biking, swimming).
  • Progression & Volume (VP): As pain and function improve, gradually increase exercise duration, frequency, or weight-bearing load. If necessary, progress to higher-level walking or strength training under the guidance of a physician or physical therapist.
  Throughout the rehabilitation process, closely monitor any exacerbation of pain, foot swelling, or other complications, and consult a specialist for timely adjustments if needed.

Disclaimer: This report is a reference analysis based on limited information and does not replace in-person consultation or professional medical advice. If you have any questions or changes in your condition, please seek medical attention promptly.