Presentation
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
From the case:
Posterior tibialis tendon dysfunction
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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.