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A 39-Year-Old Man With Ankle Pain and Stiffness

BACKGROUND

A 39-year-old man presents to his primary care physician with a 6-month
history of pain in his right ankle. The pain has been insidious, and it
is accompanied by stiffness and swelling of the ankle joint. The
patient cannot move his ankle well. Additionally, despite using a
crutch, he cannot perform his daily activities. The patient has no
history of trauma to the affected joint. There is no history of fever,
back pain, or any other joint involvement. He has no history of
sexually transmitted diseases, and his family history is negative for
arthritis.On physical examination, the patient has normal vital signs. The
cardiac findings are negative for murmurs or rubs. No rash or penile
discharge is observed. Examination of the right ankle elicits
discomfort with passive range of motion, revealing limitations with
inversion and eversion and with flexion and extension. On palpation,
the patient has mild tenderness. There is obvious swelling of the
joint, which feels firm. There is no warmth or redness over the joint.
The remainder of the physical examination is unremarkable.

A plain radiograph of the ankle is obtained (see Image 1).
After the results of the plain radiograph are interpreted, the primary
care physician orders a follow-up magnetic resonance imaging (MRI) scan
of the joint (see Images 2 through 4).

What is the diagnosis?