CLINICAL HISTORY.—An 11-year-old Caucasian boy was examined because of pain which had been present in his left ankle for approximately two months. The pain was most pronounced in the morning, becoming less bothersome as the day progressed. The boy had limped intermittently for several years, but the parents had not considered it significant to seek medical advice.
There was full range of motion of all joints with the exception of the left ankle, where crepitus was noted on dorsal and plantar flexion.
The results of a hemogram, sedimentation rate, serum calcium, and phosphorus and alkaline phosphatase were within normal limits. Because of abnormalities detected on the radiographs of the left ankle (Figure, top left), roentgenograms of joints of all extremities were obtained which showed similar changes, but of variable degrees (Figure, bottom left, and right). The dorsolumbar spine was normal.
Top Left, Radiographs of the left ankle. Bottom Left, Radiographs