Presentation
History of cut injury by scissors to right ankle medial aspect about 4 weeks earlier.
Patient Data
There is irregular hypoechoic scar at site of injury. Tibialis posterior tendon, flexure digitorum tendon and posterior tibial artery could not be identified in scar region.
Tibialis posterior tendon
- complete tendon tear
- distance between two ends of tendon about 40 mm
- proximal end just cranial to medial malleolus
Flexor digitorum longus tendon
- complete tendon tear
- distance between two ends of tendon about 23 mm
- proximal end just below medial malleolus
Posterior tibial artery
- length of about 10 mm of artery not seen at scar level
- proximal and distal arterial segments show wall thickening
- pre-occlusion type flow is seen proximal to scar, in keeping with complete obstruction
- there is collateral supply to distal segment
Posterior tibial nerve
- nerve is normal, including its three divisions
Flexor hallucis longus tendon
- intact with normal echotexture
- no tear or tenosynovitis
Case Discussion
Boy presented with history of cut injury to medial ankle region about 4 weeks back. Patient was treated by GP with local dressing without suturing. On day of presentation, there is complete healing of superficial wound. However, there is diffuse swelling locally. Patient's father adds history of profuse bleeding at the time of injury. Patient is referred for evaluation of medial ankle tendon integrity.
Ultrasound showed tendinous and vascular injury, sparing the nerves.
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