Tears of the posterior tibial tendon (PTT) are rare in athletes. Overuse syndromes leading to tendinopathy and tenosynovitis are more common in sports such as tennis and soccer, which require a great deal of side to side movement. As long as the feet are happy, stars like David Beckham can make great plays:
An uncommon ankle injury worth remembering is dislocation of the posterior tibial tendon. Thirty year-old male with medial ankle pain:
Axial proton-density (PD) and T2-weighted images reveal a medially dislocated posterior tibial tendon (red arrows).
Here are comparison images from a normal individual, depicting the normal posterior tibial tendon (green arrow), behind the medial malleolus (yellow arrows). (The bright oval laterally is a skin marker, and can be ignored):
A coronal intermediate image from the abnormal patient confirms the abnormal position of the PTT, superficial and medial to the medial malleolus:
Dislocation of the PTT is a rare condition, and diagnosis is often delayed. The MRI diagnosis of this condition has been described by Bencardino et al. (AJR 169:1109-1112, 1997). Most lesions involve tearing of the flexor retinaculum, but some cases are due to an incompetent flexor retinaculum (AJSM 29:656-689, 2001). Conservative therapy is not effective, and surgical repair is usually necessary.
Vic David MD