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Posterior Tibial Tendon Dysfunction
Corrie M. Yablon, MD; Julia R. Crim, MD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Pathology

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Posterior tibial tendon (PT)
            • Flexor digitorum longus tendon (FDL)
            • Posterior tibial tendon dysfunction (PTTD)
              • Spectrum of clinical and imaging findings of PT abnormalities
          • Synonyms

            • Tibialis posterior tendon
            • Accessory navicular = os naviculare
          • Definitions

            • Type I accessory navicular: sesamoid embedded within PT, just proximal to navicular
              • a.k.a. os tibiale externum
            • Type II accessory navicular: accessory center of ossification united to parent navicular by synchondrosis
            • Synchondrosis: cartilage connection between parent bone and ossicle
            • Type III accessory navicular: enlarged medial horn of navicular = cornuate navicular

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Relevant Anatomy

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Bernasconi A et al: Role of minimally invasive surgery in adult flatfoot deformity. Foot Ankle Clin. 25(3):479-91, 2020
                                          2. Kwon KB et al: Posterior tibial tendon integrity can be screened with plain anteroposterior foot radiography. Orthopedics. 1-5, 2020
                                          3. Soliman SB et al: Sonographic and radiographic findings of posterior tibial tendon dysfunction: a practical step forward. Skeletal Radiol. 48(1):11-27, 2019
                                          4. Lin YC et al: The hindfoot arch: what role does the imager play? Radiol Clin North Am. 54(5):951-68, 2016
                                          5. Arnoldner MA et al: Imaging of posterior tibial tendon dysfunction-comparison of high-resolution ultrasound and 3T MRI. Eur J Radiol. 84(9):1777-81, 2015
                                          6. Donovan A et al: Extraarticular lateral hindfoot impingement with posterior tibial tendon tear: MRI correlation. AJR Am J Roentgenol. 193(3):672-8, 2009
                                          7. Nallamshetty L et al: Evaluation of posterior tibial pathology: comparison of sonography and MR imaging. Skeletal Radiol. 34(7):375-80, 2005
                                          8. Balen PF et al: Association of posterior tibial tendon injury with spring ligament injury, sinus tarsi abnormality, and plantar fasciitis on MR imaging. AJR Am J Roentgenol. 176(5):1137-43, 2001
                                          9. Pomeroy GC et al: Acquired flatfoot in adults due to dysfunction of the posterior tibial tendon. J Bone Joint Surg Am. 81(8):1173-82, 1999
                                          10. Khoury NJ et al: MR imaging of posterior tibial tendon dysfunction. AJR Am J Roentgenol. 167(3):675-82, 1996
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Posterior tibial tendon (PT)
                                                    • Flexor digitorum longus tendon (FDL)
                                                    • Posterior tibial tendon dysfunction (PTTD)
                                                      • Spectrum of clinical and imaging findings of PT abnormalities
                                                  • Synonyms

                                                    • Tibialis posterior tendon
                                                    • Accessory navicular = os naviculare
                                                  • Definitions

                                                    • Type I accessory navicular: sesamoid embedded within PT, just proximal to navicular
                                                      • a.k.a. os tibiale externum
                                                    • Type II accessory navicular: accessory center of ossification united to parent navicular by synchondrosis
                                                    • Synchondrosis: cartilage connection between parent bone and ossicle
                                                    • Type III accessory navicular: enlarged medial horn of navicular = cornuate navicular

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Staging, Grading, & Classification

                                                                    • Relevant Anatomy

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Bernasconi A et al: Role of minimally invasive surgery in adult flatfoot deformity. Foot Ankle Clin. 25(3):479-91, 2020
                                                                                  2. Kwon KB et al: Posterior tibial tendon integrity can be screened with plain anteroposterior foot radiography. Orthopedics. 1-5, 2020
                                                                                  3. Soliman SB et al: Sonographic and radiographic findings of posterior tibial tendon dysfunction: a practical step forward. Skeletal Radiol. 48(1):11-27, 2019
                                                                                  4. Lin YC et al: The hindfoot arch: what role does the imager play? Radiol Clin North Am. 54(5):951-68, 2016
                                                                                  5. Arnoldner MA et al: Imaging of posterior tibial tendon dysfunction-comparison of high-resolution ultrasound and 3T MRI. Eur J Radiol. 84(9):1777-81, 2015
                                                                                  6. Donovan A et al: Extraarticular lateral hindfoot impingement with posterior tibial tendon tear: MRI correlation. AJR Am J Roentgenol. 193(3):672-8, 2009
                                                                                  7. Nallamshetty L et al: Evaluation of posterior tibial pathology: comparison of sonography and MR imaging. Skeletal Radiol. 34(7):375-80, 2005
                                                                                  8. Balen PF et al: Association of posterior tibial tendon injury with spring ligament injury, sinus tarsi abnormality, and plantar fasciitis on MR imaging. AJR Am J Roentgenol. 176(5):1137-43, 2001
                                                                                  9. Pomeroy GC et al: Acquired flatfoot in adults due to dysfunction of the posterior tibial tendon. J Bone Joint Surg Am. 81(8):1173-82, 1999
                                                                                  10. Khoury NJ et al: MR imaging of posterior tibial tendon dysfunction. AJR Am J Roentgenol. 167(3):675-82, 1996