eMedicine Specialties > Radiology > Musculoskeletal
Ankle, Tibialis Posterior Tendon Injuries: Multimedia
Updated: Feb 5, 2008
Multimedia
 | Media file 1: Ankle, tibialis posterior tendon injuries. Axial T2-weighted fat-suppressed MRI in an adult man with peritendinous edema. Image reveals reactive marrow edema (open arrow) under the tibialis posterior tendon groove; this is caused by tibialis posterior tendon dysfunction. |
 | Media file 2: Ankle, tibialis posterior tendon injuries. Sagittal fast short-tau inversion recovery (STIR) MRI in a middle-aged woman with insertional tendonitis. Image reveals fluid and diffuse flocculent signal intensity in the distal tibialis posterior tendon; this is consistent with insertional tendonitis (open arrow). Note the adjacent soft-tissue edema. Also note the longitudinal areas of high signal intensity in the tendon; this finding is consistent with an interstitial tear. |
 | Media file 3: Ankle, tibialis posterior tendon injuries. Axial T1-weighted MRI in an adult woman with tibialis posterior tenosynovitis. Image reveals the speckled internal signal intensity of the tibialis posterior tendon (open arrow). |
 | Media file 4: Ankle, tibialis posterior tendon injuries. Same patient as in Picture 6; STIR-weighted MRI in an adult woman with tibialis posterior tenosynovitis. The signal intensity is more intense on this image than on others and it is associated with synovitis (open arrow). |
 | Media file 5: Ankle, tibialis posterior tendon injuries. Axial T2-weighted MRI in a middle-aged woman with an atrophic tear. Image reveals an attenuated, threadlike, tibialis posterior tendon (open arrow) consistent with an atrophic-type tear. |
 | Media file 6: Ankle, tibialis posterior tendon injuries. Axial T2-weighted MRI in a middle-aged woman with an atrophic tendon and a tibial spur. Image reveals a thinned tibialis posterior tendon (open arrow) that is adjacent to a spur (arrowhead); this finding is characteristic of tibialis posterior tendon dysfunction. |
 | Media file 7: Ankle, tibialis posterior tendon injuries. Axial T2-weighted MRI in a middle-aged man with a hypertrophic tear reveals an enlarged tendon (open arrow) adjacent to the deltoid ligament (arrow). This tibialis posterior tendon is roughly 3-4 times the size of the adjacent flexor hallucis and flexor digitorum tendons; this finding is consistent with hypertrophic dysfunction. |
 | Media file 8: Ankle, tibialis posterior tendon injuries. Sagittal short-tau inversion recovery MRI in a middle-aged man with mixed hypertrophic and atrophic tendon tear. Image reveals a focal tear of the submalleolar (arrowhead) with tendon thinning. Retracted fibers cause spurious tendon thickening (open arrow). |
 | Media file 9: Ankle, tibialis posterior tendon injuries. Same patient as in Multimedia Image 55; longitudinal sonogram in a young healthy woman shows minimal fluid (open arrow) seen adjacent to distal tibialis posterior tendon. |
 | Media file 10: Ankle, tibialis posterior tendon injuries. Drawing shows the relationship of the tibialis posterior tendon to the remainder of the tarsal tunnel. Note the relative sites and the distal extent of tendon sheaths in black. Also note that the flexor hallucis and flexor digitorum tendons cross distally at the knot of Henry (straight arrow). Last, note the tibial artery and nerve (curved arrow) between the flexor digitorum longus tendon and the flexor hallucis longus tendon in the tarsal tunnel. ATT, anterior tibialis tendon; FDL, flexor digitorum longus tendon; FHL, flexor hallucis longus tendon; FR, flexor retinaculum; and PTT, tibialis posterior tendon. |
 | Media file 11: Ankle, tibialis posterior tendon injuries. Sagittal T1-weighted MRI in a middle-aged woman with tibialis posterior tendon tear reveals straightening of normal malleolar curve. The patient has a markedly thickened tibialis posterior tendon (open arrow) with a large segment of internal signal intensity (white arrows). |
 | Media file 12: Ankle, tibialis posterior tendon injuries. Drawing shows the complex insertions of the tibialis posterior tendon beneath the undersurface of the foot with the muscle dissected away. Note the main slip inserting onto the tubercle of the navicular. Also note the close anatomic relationship of the distal tendon, spring ligament, and distal deltoid ligament. C, calcaneus; N, navicular; PTT, tibialis posterior tendon. |
 | Media file 13: Ankle, tibialis posterior tendon injuries. Axial unenhanced T1-weighted MRI in a healthy adult male shows normal low-signal intensity tibialis posterior (long arrow) and flexor digitorum longus (short arrow) tendons; note the relative sizes. |
 | Media file 14: Ankle, tibialis posterior tendon injuries. Same patient as in Picture 13; axial unenhanced STIR weighted MRI in a healthy adult male shows normal low-signal intensity tibialis posterior (long arrow) and flexor digitorum longus (short arrow) tendons; note the relative sizes. |
 | Media file 15: Ankle, tibialis posterior tendon injuries. T1-weighted fat-suppressed MRI in a young healthy man shows the ratio of the sizes of the tibialis posterior tendon (open arrow) and the flexor digitorum tendon (solid arrow). Also note how the normal tibialis posterior tendon is slightly smaller than the summated peroneal tendons (arrowhead). |
 | Media file 16: Ankle, tibialis posterior tendon injuries. Lateral plain radiograph of a flat foot resulting from long-standing tibialis posterior tendon rupture. |
 | Media file 17: Ankle, tibialis posterior tendon injuries. Lateral tenogram shows extrinsic compression on tibialis posterior tenograms at the level of the tibial plafond produced by the flexor retinaculum (between arrowheads). This should not to be mistaken for pathologic adhesion or stenosis. Note the injecting needle (arrow). |
 | Media file 18: Ankle, tibialis posterior tendon injuries. Tenogram shows 6-10 sacculations (arrowheads) suggesting moderate tenosynovitis of the tibialis posterior tendon sheath. Note normal narrowing of the tendon sheath (between arrows) overlies the tibial plafond. |
 | Media file 19: Ankle, tibialis posterior tendon injuries. Tenogram shows more than 10 sacculations along the margins of the tibialis posterior tendon sheath suggestive of severe tenosynovitis. Note the defect in the distal tibialis posterior tendon sheath allowing contrast material to pass into the talonavicular joint and the distal subtalar facet (arrows). |
 | Media file 20: Ankle, tibialis posterior tendon injuries. Lateral tenogram depicts a filling defect/mass effect (arrowheads) of the tibialis posterior tendon representing a tear, which was confirmed at surgery. |
 | Media file 21: Ankle, tibialis posterior tendon injuries. Lateral tenogram depicts a mass/filling defect (arrows), which represents a torn tibialis posterior tendon. Note contrast material, which fills the sheaths of both the tibialis posterior tendon and the flexor digitorum longus (arrowheads) tendon. |
 | Media file 22: Ankle, tibialis posterior tendon injuries. Axial T1-weighted image at the level of the dome of the talus showing thickening of the tibialis posterior tendon with adjacent soft tissue edema replacing the surrounding subcutaneous fat. |
 | Media file 23: Ankle, tibialis posterior tendon injuries. Same patient as in Image 22 in Multimedia; image taken at a slightly distal axial plane showing the progression of tibialis posterior tendon damage. |
 | Media file 24: Ankle, tibialis posterior tendon injuries. Sagittal T1-weighted image showing thickening of the tibialis posterior tendon with adjacent soft tissue edema replacing the surrounding subcutaneous fat at and below the medial malleolus. |
 | Media file 25: Ankle, tibialis posterior tendon injuries. Sagittal T1-weighted image showing thickening of the tibialis posterior tendon with adjacent soft tissue edema replacing the surrounding subcutaneous fat at and below the medial malleolus. Note straightening with loss of normal curvature of the tibialis posterior tendon at and below the medial malleolus. Same patient as in Image 24 in Multimedia. |
 | Media file 26: Ankle, tibialis posterior tendon injuries. Sagittal T1-weighted MRI in an adult healthy man shows a low-signal-intensity tibialis posterior tendon (open arrow). Note the normal smooth curve that the tibialis posterior tendon makes as it extends from the medial malleolus. |
 | Media file 27: Ankle, tibialis posterior tendon injuries. Same patient as in Image 5 in Multimedia; sagittal T2-weighted fat-suppressed MRI in an adult healthy man shows a low-signal-intensity tibialis posterior tendon (open arrow). |
 | Media file 28: Ankle, tibialis posterior tendon injuries. Sagittal proton density MRI in a healthy adult man reveals the normal smooth malleolar curve of the tibialis posterior tendon (open arrows). |
 | Media file 29: Ankle, tibialis posterior tendon injuries. Axial STIR (short-tau inversion recovery) MRI in a woman with tendon dysfunction and subtendinous edema. Image reveals edema in the medial malleolus related to tibialis posterior tendon dysfunction (open arrow). |
 | Media file 30: Ankle, tibialis posterior tendon injuries. Coronal T2-weighted image showing absence of the tibialis posterior tendon due to complete tear with fluid signal filling the tendon sheath and soft tissue edema replacing the surrounding subcutaneous fat. |
 | Media file 31: Ankle, tibialis posterior tendon injuries. Coronal T2-weighted image (same patient as in Image 30 in Multimedia, slightly posterior planes) showing absence of the tibialis posterior tendon due to complete tear with fluid signal filling the tendon sheath and soft tissue edema replacing the surrounding subcutaneous fat. |
 | Media file 32: Ankle, tibialis posterior tendon injuries. Axial contrast-enhanced fat-suppressed MRI in a middle-aged man with synovitis and interstitial tear reveals excessive contrast enhancement around the tibialis posterior tendon (open arrow) in the region of the medial malleolus; this finding is consistent with synovitis. Enhancement is also seen in the tibialis posterior tendon; this is suggestive of an interstitial tear. |
 | Media file 33: Ankle, tibialis posterior tendon injuries.Same patient as in Image 38 in Multimedia; axial T2-weighted fat-suppressed MRI in a young adult man. Note that internal signal intensity in tibialis posterior tendon fades on long-TE images. This finding is consistent with magic-angle artifact (open arrow). |
 | Media file 34: Ankle, tibialis posterior tendon injuries. MRI T1-weighted in an adult man with a normal tibialis posterior tendon. Image shows the close proximity of the tibialis posterior tendon (arrowhead); spring ligament (curved arrow); and tibial navicular ligament (open arrow), which gives the appearance of a thickened distal tibialis posterior tendon. |
 | Media file 35: Ankle, tibialis posterior tendon injuries. Same patient as in Multimedia Images 36 and 37 (few months after conservative management); axial STIR MRI in an adult woman with peritendinosis. Image shows enhancement of the peritendinous area (open arrow) with slight increase in fluid signal. |
 | Media file 36: Ankle, tibialis posterior tendon injuries. Axial T1-weighted MRI of the ankle in a young adult woman with peritendinosis shows increased soft tissue with mixed signal intensity in the peritendinous area (open arrow) in addition to tendon thickening. |
 | Media file 37: Ankle, tibialis posterior tendon injuries. Same patient as in Multimedia Image 36; axial T2-weighted MRI in a young woman with peritendinosis reveals mixed signal intensity and increased peritendinous soft tissue (open arrow). |
 | Media file 38: Ankle, tibialis posterior tendon injuries. Axial T1-weighted MRI in a young adult man shows diffuse internal signal in the tibialis posterior tendon (arrow). |
 | Media file 39: Ankle, tibialis posterior tendon injuries. Axial T1-weighted image at the level of the talus showing thickening of the tibialis posterior tendon containing subtle foci of increased signal intensity with adjacent soft tissue edema replacing the surrounding subcutaneous fat. |
 | Media file 40: Ankle, tibialis posterior tendon injuries. Axial T1-weighted image at the level of the talus showing thickening of the tibialis posterior tendon containing subtle foci of increased signal intensity with adjacent soft tissue edema replacing the surrounding subcutaneous fat. |
 | Media file 41: Ankle, tibialis posterior tendon injuries. Axial T1-weighted image at the level of the talus showing thickening of the tibialis posterior tendon with adjacent soft tissue edema replacing the surrounding subcutaneous fat. Note the enlarged tibialis posterior tendon relative to the flexor digitorum, flexor hallucis, and tibialis anterior tendons. Same patient as in Image 40 in Multimedia. |
 | Media file 42: Ankle, tibialis posterior tendon injuries. T1-weighted MRI of the ankle. Coronal image shows thickening of the tibialis posterior tendon (arrowhead) with increased internal signal intensity. There is marrow edema immediately subjacent to the medial malleolus seen on the T2-weighted images. |
 | Media file 43: Ankle, tibialis posterior tendon injuries. Axial intermediate-weighted MRI in a middle aged man with an interstitial tendon tear. Image reveals an enlarged tibialis posterior tendon with several linear regions of signal intensity that split tibialis posterior tendon into fascicles (open arrow). |
 | Media file 44: Ankle, tibialis posterior tendon injuries. Axial T2-weighted MRI in an adult man with a dislocated tibialis posterior tendon. Image reveals that the tibialis posterior tendon is dislocated anteriorly, out of its groove (arrow). Note how the normal flexor digitorum tendon (open arrow) remains posterior to tibia, while the tibialis posterior tendon is subluxed medially and anteriorly. |
 | Media file 45: Ankle, tibialis posterior tendon injuries. Axial proton density–weighted MRI in a middle-aged woman with a subluxed tendon. Image reveals that the tibialis posterior tendon (open arrow) is slightly subluxed medially, out of its groove (arrowhead). |
 | Media file 46: Ankle, tibialis posterior tendon injuries. Sagittal T2-weighted MRI in a middle-aged woman with a talonavicular fault. Image reveals that a line drawn along the long axis of talus extends inferiorly rather than bisecting the navicular. |
 | Media file 47: Ankle, tibialis posterior tendon injuries. Axial T2-weighted MRI in a middle-aged man with talonavicular unroofing. Image shows unroofing of the upper aspect of the talus with the navicular subluxed laterally (arrowhead), exposing the medial talonavicular head; this is a secondary sign of tibialis posterior tendon insufficiency. There is also an interstitial tear of the tibialis posterior tendon (open arrow). |
 | Media file 48: Ankle, tibialis posterior tendon injuries. Coronal T1-weighted MRI in an adult man with tendon dysfunction and heel valgus. Image reveals heel valgus. Lines of reference go through the long axes of the tibia and calcaneus. |
 | Media file 49: Ankle, tibialis posterior tendon injuries. Axial proton density weighted MRI in an adult man at risk for tibialis posterior dysfunction. Image shows hypertrophy of navicular tubercle (open arrow), consistent with a cornuate navicular. |
 | Media file 50: Ankle, tibialis posterior tendon injuries. Sagittal T2-weighted MRI in a man at risk for posterior tibialis dysfunction reveals accessory navicula (a). Note the straight line (instead of the normal smooth curve) that the tibialis posterior tendon makes as it extends from the medial malleolus. This abnormality causes a focal point of friction at the medial malleolus (open arrow). |
 | Media file 51: Ankle, tibialis posterior tendon injuries. Same patient as in Image 50 in Multimedia; axial intermediate-weighted MRI in a young adult at risk for tibialis posterior tendon dysfunction shows the accessory navicular with low-signal-intensity synchondrosis (open arrow). |
 | Media file 52: Ankle, tibialis posterior tendon injuries. T2-weighted fat-suppressed MRI of the ankle in an adult woman with several months' history of medial ankle pain and tibialis posterior tendinopathy that is associated with subtendinous bone marrow edema of the medial malleolus. Axial image shows thickening of the tibialis posterior tendon (arrow). Note the marrow edema immediately subjacent to the medial malleolus (open arrow). |
 | Media file 53: Ankle, tibialis posterior tendon injuries. Same patient as in Image 52 in Multimedia; T2-weighted fat-suppressed fast MRI of the ankle. Sagittal image shows thickening of the tibialis posterior tendon with increased internal signal intensity (arrow). Note the marrow edema immediately subjacent to the medial malleolus (open arrow). |
 | Media file 54: Ankle, tibialis posterior tendon injuries. Axial T2-weighted MRI in an adult man with accessory navicular pseudoarthrosis. Image reveals fluid between the navicular and accessory navicular; this is consistent with pseudoarthritis. Also note the edema in both bones (open arrows); this reflects altered mechanics. |
 | Media file 55: Ankle, tibialis posterior tendon injuries. Longitudinal sonogram in a young healthy woman shows a normal tibialis posterior tendon (between calipers). Arrow points to the medial malleolus. |
 | Media file 56: Ankle, tibialis posterior tendon injuries. Same patient as in Multimedia Images 9 and 55; transverse sonogram in a young healthy woman shows a normal tibialis posterior tendon (between calipers). Open arrow points to the flexor digitorum longus tendon adjacent to tibialis posterior tendon. |
 | Media file 57: Ankle, tibialis posterior tendon injuries. Same patient as in Multimedia Image 58; transverse color Doppler sonogram of tibialis posterior tendon in a young adult with tendinosis and peritendinosis. Image shows peritendinous (open arrow) and intratendinous (arrowheads) flow. |
 | Media file 58: Ankle, tibialis posterior tendon injuries. Same patient as in Image 39 in Multimedia; transverse sonogram in a middle-aged woman with tendinosis shows an enlarged inhomogeneous tibialis posterior tendon (between calipers). |
 | Media file 59: Ankle, tibialis posterior tendon injuries. Transverse sonogram in a young adult woman with peritendinosis (open arrow points to low echogenicity in peritendinous area). |
More on Ankle, Tibialis Posterior Tendon Injuries |
| Overview: Ankle, Tibialis Posterior Tendon Injuries |
| Imaging: Ankle, Tibialis Posterior Tendon Injuries |
| Follow-up: Ankle, Tibialis Posterior Tendon Injuries |
 Multimedia: Ankle, Tibialis Posterior Tendon Injuries |
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Further Reading
Keywords
tibialis posterior tendon Injury, tibialis posterior tendon dysfunction, ankle injury, tendinitis, tendonitis, tendonosis
