Text2
subheading
2
3
4
Text
Text
subheading
>>
Text3
---|>
3
4
5
3
4
5
Figure6
Text4   
Figure7
Figure9
Text4   
Figure10
Figure8
Figure9
Figure10
Figure11
Figure12
Figure13
Ankle & Foot
Shoulder
Elbow
Wrist & Hand
Hip
Knee
Ankle & Foot
Home
Medial Pain
Lateral Pain
.
Posterior pain
Anterior pain
Forefoot Pain
Miscellaneous
Tibialis Posterior
FHL
Deltoid Ligament
Spring Ligament
Tarsal Tunnel
.
.
.
.
.
.
.
.
Tibialis posterior is the largest of the tendons that lie in the medial aspect of the ankle. It runs in close proximity to flexor digitorum which lies on its dorsal aspect. The third tendon that lies in the medial aspect is flexor hallucis longs. This lies some distance from the other two tendons but the three are considered together and remembered by the mnemonic Tom, Dick and Harry. Tibialis posterior and flexor digitorum longs are contained within the tarsal tunnel bounded laterally by the flexor retinaculum. A number of other important structures are found within the tunnel including the posterior tibial neurovascular bundle. Abnormalities of each of these structures can contribute to medial ankle pain. Disorders of tibialis posterior tendon include tenosynovitis, tendinopathy, partial and complete tears and rarely subluxation. These abnormalities are most commonly encountered in the middle age female population. Clinically the patient complains of pain, clinical examination reveals tenderness over the tendon along with, as the disease progresses, flattening of the medial arch of the foot. Tibialis posterior tendon is a significant contributor to preservation of the medial arch and functions along with the spring ligament to preserve its integrity.
.
.
.
Tenosynovitis represents an early stage in tibialis posterior tendon disease. There is an increase in fluid and synovial thickening on to the tendon. Note that a small quantity of fluid may be detected in the tendon sheath under normal circumstances. Depending on the position of the leg, fluid tends to gravitate in the sub-malleolar region. Normal fluid should not be conspicuous, nor should it show any complexity either on MR or ultrasound. Doppler ultrasound is also helpful in demonstrating increased blood flow. Various grades of tenosynovitis may be encountered. In some cases a significant synovial mass may form and indent or displace the tendon.Occasionally calcification can be identified within the tendon sheath. This is easier to detect on ultrasound and plain radiography than it is on MR. Patients with calcific tendinopathy often present with acute symptoms as crystal shedding can be particularly painful.Tibialis posterior tendon rupture can be partial or complete. Partial rupture takes two forms, one where the tendon is enlarged and another where it is atrophic. Hypertrophic tendinopathy is the commonest manifestation. As the name implies, the tendon is enlarged with areas of mucoid degeneration which manifesses intermediate signal on T1 weighted images and increased signal on T2. On ultrasound the tendon also appears enlarged with areas of decreased reflectivity associated with vascular ingrowth.
.
.
.
.
.
.
.
.
.