
HI Xue,
Tricky one !
The question in my mind is “did the tree fall cause the pathology or was that event a coincidence”
If the tree fall had nothing to do with it we could be looking at a rheumatoid patient.
But you said there was a hyperechoic free body. Did this look like a foreign body?
If it was a splinter from the tree are we looking at a chronic infection?
There is certainly a lot of inflammation in the soft tissues. The question is whether it is synovial proliferation from something like rheumatoid or a chronic infection from the fall.
he extender digitorum brevis muscle is lateral to this location so I don’t think it has anything to do with it.
There is a bursa under the tib ant tendon and it could be a chronic bursitis of that bursa.
It looks like it is getting worse as I notice you have sent me films from 2 dates.
So :
Rheumatoid
Gout
Foreign body – chronic infection
Bursitis
Steve