Posterior tibialis tendon tear

Case contributed by Domenico Nicoletti
Diagnosis certain


Cut wound on the medial surface of the ankle with acute flatfoot.

Patient Data

Age: 30 years
Gender: Male

Left ankle


Axial T2-weighted and STIR-weighted images show the “empty sheath” sign, with no tendon in the posterior tibialis tendon sheath. In the coronal T1 sequence, a retraction of the proximal stump of approximately 5 cm is detectable; furthermore, on the upper part of the talus, medially, there is also a small osteochondral lesion. There is an associated area of bone marrow edema in the posteromedial aspect of the tibia. The remaining objectivity is within the limits of the normal.

Case Discussion

The posterior tibialis tendon determines plantar flexion, adduction and inversion of the foot, ensuring support for the arch of the foot. Acute complete rupture of the posterior tibialis tendon leads to acute flatfoot.

TSRM: Nunzio Bianco

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