55-year-old female with posterior tibial tendon dysfunction and sensation of instability

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Posterior tibial tendon dysfunction evaluate for rupture. Medial ankle pain and sensation of instability.

Long- and short-axis fat- and water-weighted images were performed.  

  • Tendons:  
    • Large high-grade supramalleolar retromalleolar and inframalleolar tear with cystic degeneration and marked hypertrophy of the tendon with a length of greater than 5-6cm.  
  • Lateral group normal.  
  • Anterior group normal.  
  • Posterior group normal.  
  • Skeleton:  
    • Hypertrophic bifid posterior tibial tendon groove behind the tibia likely contributing to giant cystic tear of the posterior tibial tendon.    
  • Inflamed intraosseous ganglion of the inferior talus.  
  • Soft Tissues:  
    • Subtalar space bursal swelling.  
  • Articular:  
    • First tarsometatarsal joint class 4 chondromalacia.    
  • 1+ effusion.  
  • Plantar Fascia:  
    • Normal.  
  • Neurovascular Bundle:  
    • Normal.  
  • Soft Tissue Masses:  
    • None other than pseudomass of posterior tibial tendon.  
  • Haglund Deformity:  
    • Small posterosuperomedial present.    
  • Collaterals:  
    • Intact.  
  • Soft Tissues:  
    • Swollen medially and along the anterolateral soft tissue region.

Larger giant hypertrophic cystic tear of the supra- juxta- and inframalleolar posterior tibial tendon with stretched laciniate ligament or medial retinaculum and developmental variation of bifid posterior tibial tendon bony groove.

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