Interactive Transcript
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MRI examination on a 64-year-old man who
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is presenting with medial ankle pain.
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On the left, axial fat-
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suppressed T2-weighted images.
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In the center, T2-weighted
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images without fat suppression.
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And on the right, sagittal state images.
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The medial flexor compartment is abnormal.
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We see thickening of the posterior tibial tendon,
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which has a fusiform hypertrophic configuration
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with multiple intrasubstance longitudinal
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split hairs and associated tenosynovitis with
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a small effusion within the tendon sheath.
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Also noted is thickening of the flexor
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retinaculum as it attaches into the medial
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margin of the tibial retromalleolar groove
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with an associated small enthesophyte.
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So this is due to traction-related
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enthesopathy of the flexor retinaculum
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at the insertion into the bone.
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With associated reactive marrow edema,
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ancillary findings of posterior tibial
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tendon dysfunction in a patient who was
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also presenting with flat foot deformity.
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The posterior tibial tendon is the main
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dynamic stabilizer of the medial longitudinal
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arch and is frequently disrupted in patients
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who have acquired this planus deformity.
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So in this patient, to summarize, we have severe
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tendinosis of the posterior tibial tendon
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manifested by fusiform thickening of the
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tendon in the supramalleolar and infra-
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malleolar regions with longitudinal splitter
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of the fibers and associated vir and
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enthesopathy at the insertion of the flexor.
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