Longitudinal split tear of peroneus brevis

Case contributed by Dr Utkarsh Kabra

Presentation

Pain around ankle joint

Patient Data

Age: 65 years
Gender: Female

Tendinosis of peroneus brevis and longus tendons is seen with longitudinal split tear of peroneus brevis tendon at the level of retromalleolar groove with resultant boomerang/cashew nut appearance. Mild anterior subluxation of peroneus longus tendon is seen within this gap.  

Fluid along supramalleolar, retromalleolar and inframalleolar segments of tibialis posterior and flexor digitorum longus tendon with areas of thickening and hyperintensity of these tendons, predominantly in inframalleolar segment.

Mild sprain of deep fibers of deltoid ligament and spring ligament is seen.

Subtle cortical irregularity with mild marrow edema is seen involving medial aspects of navicular bone.  

Significant subcutaneous edema is seen at the medial aspect of ankle joint. 

Marginal osteophytes, articular cartilage irregularity, subchondral erosions / cystic changes are seen at first, second, third tarso-metatarsal joints and navicular - medial cuneiform joints.  

Mild achilles tendinosis is seen.

Small bony spur is seen along planter aspect of calcaneum medially. However, no obvious planter fasciitis seen. 

Lateral ligaments of ankle joint are normal. 

Distal tibia, fibula bones appear normal with no evidence of marrow edema.

 

Case Discussion

Tendinosis of peroneus brevis and longus tendons with longitudinal split tear of peroneus brevis tendons at the level of retromalleolar groove. Mild anterior subluxation of peroneus longus tendon is seen within this gap.  
Fluid along supramalleolar, retromalleolar and inframalleolar segments of tibialis posterior and flexor digitorum longus tendon with areas of thickening and hyperintensity of these tendons, predominantly in inframalleolar segment consistent with tenosynovitis and paratenonitis.   

Significant subcutaneous edema at medial aspect of ankle joint. 

Marginal osteophytes, articular cartilage irregularity, subchondral erosions / cystic changes at first, second, third tarso-metatarsal joints and navicular - medial cuneiform joints consistent with osteoarthritic changes.  

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