Figure 1. A) X-ray Left Ankle - periosteal reaction in the medial aspect of the distal left tibia; B) X-ray Left foot - Degenerative changes are noted in the tarsometatarsal joints and the first MTP joint. A calcaneal plantar spur is noted; C and D) Isotope bone scan - linear increased uptake in the distal cortex of both tibias, particularly on the medial aspect. There is also some increased uptake in the cortex of the distal femoral shafts bilaterally.