Tibialis posterior tear

Case contributed by Dr Dalia Ibrahim


Left ankle pain, posterior to the medial malleolus

Patient Data

Age: 40
Gender: Female

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).



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'.


PlayAdd to Share

Case information

rID: 29711
Published: 17th Jun 2014
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.