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<v ->Now there are certain sites where we now have learned

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that marrow alterations are typically reversible.

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And this is one described in the immature skeleton

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involving multiple bones of the hind foot and midfoot

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sometimes in association with involvement

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of the distal tibia.

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Now there were a number of articles that talked about this

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in the feet of children,

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that you would see these patchy areas

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of altered marrow signal.

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I'm gonna mention a couple of characteristics

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about them in a moment.

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There wasn't certain why they were there.

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Some theory were that these were stress related.

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There was a theory

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that these were wandering islands of hematopoietic marrow.

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I don't think that theory stayed around.

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We see these in active children.

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And I think it's a normal response to the physical activity,

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inducing some hyperemia within the bones.

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So here's an example.

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Here's another example.

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And I think it's just a typical overuse

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that you see in active children.

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The most common sites are the talus and calcaneus,

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(indistinct) and the bone through it,

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but those two are most frequently involved.

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There may be a slight increase

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in the frequency of joint fluid,

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such that you may see more than physiologic joint fluid.

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Rather, you may see small joint effusions.

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And in my experience,

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the alterations in marrow signal

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may be border forming, okay.

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Or most prominent at sites of tendon attachment.