Case 26 Answer

Answer: Anterior calcaneous process fracture

 I was convinced this was going to be an avulsion fx of the extensor digitorum brevis from the lateral calcaneous (kinda big fragments but good location on AP ankle). Unfortunately the CT had other ideas.

Teaching point: EDB avulsion and ant calcaneous process fx can look similar on ankle X-rays (with similar clinical presentation and inversion injury). Proper foot X-rays with obliques to look at the ant calc process should really be considered in this situation.