Presentation
Left ankle pain, posterior to the medial malleolus
Patient Data
Age: 40
Gender: Female
From the case:
Tibialis posterior tear
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The tibialis posterior tendon is markedly thickened (compare it to the adjacent flexor digitorum tendon), showing intrasubstance degenerative signal and longitudinal splits, its tendon sheath is distended by fluid signal (tenosynovitis).
From the case:
Tibialis posterior tear
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Flat foot deformity
Case Discussion
Chronic posterior tibial tendon rupture is associated with flat foot deformity.
The tear is commonly noted behind medial malleolus (the significant site of friction).
Chronic posterior tibial rupture is divided into 3 types:
- type I: incomplete/partial tear with diffuse tendon enlargement showing intrasubstance degeneration/longitudinal splits.
- type II: partial tear with diffusely thinned tendon.
- type III: complete tear.
Two separate posterior tibial tendons secondary to longitudinal splitting giving the 'four tendon sign'.
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