Saturday, October 4, 2008

Beckham and the Posterior Tibial Tendon

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

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