Posterior tibialis tendon dysfunction

Case contributed by Maulik S Patel
Diagnosis certain


Left medial ankle, foot and distal leg region pain for 6 weeks. No history of trauma. Recent physical activity of daily staircase climbing for the last 8 weeks. She has left flat foot since birth.

Patient Data

Age: 45 years
Gender: Female

Tibialis posterior tendon (symptomatic side)

  • Intact
  • Tendon is diffusely odematous / thickened.
  • Tendon shows normal echopattern except few tiny hypoechoic areas in inframalleolar segment.

Tibialis posterior tendon sheath (symptomatic side)

  • Miniminal fluid is present in infra-malleolar tendon sheath.
  • Tendon insertion
  • Most of fibers are inserted into accessory navicular bone
  • Few fibers are inserted to navicular bone.
  • Pseudo-arthrosis is present between native and accessory navicular bone.

Doppler findings (symptomatic side)

  • Increased vascularity in tendon and peri-tendon region.
  • There is no vascularity in pseudo-arthrosis between native and accessory navicular bone.

Asymptomatic side

  • Accessory navicular bone present
  • Tibialis posterior tendon is normal.

Case Discussion

Middle aged patient with unilateral flat foot shows posterior tibial tendinosis and tenosynovitis. Bilateral accessory navicular bones are present.

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