Tibialis posterior tendon rupture and sinus tarsi synovitis

Case contributed by Andrew Dixon
Diagnosis almost certain


Ankle and mid foot pain.

Patient Data

Age: 65 years
Gender: Male

Major findings are complete chronic tibialis posterior tendon rupture with thickening of the spring ligament complex and pronounced sinus tarsi synovitis.  

Empty tibialis posterior tendon sheath behind the medial malleolus in keeping with tendon rupture (red arrow). Normal flexor digitorum (blue arrow) and flexor hallucis longus (yellow arrow) tendons.

Pronounced sinus tarsi synovitis (pink arrows) and thickening of the spring ligament (green arrow).   

Case Discussion

Sinus tarsi synovitis (syndrome) is a common biomechanical sequela of tibialis posterior tendon deficiency. Whenever you spot sinus tarsi synovitis you should remember to look for tibialis posterior tendinopathy/tear/rupture, and vice versa.

This case emphasizes the importance of always examining each of the tendons at the ankle (using Tom, Dick and Harry mnemonic to help you medially) as a missing tendon due to complete rupture can be difficult to appreciate unless you look for each tendon specifically.  

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