What’s the Diagnosis – Case 144
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What’s the Diagnosis – Case 144
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Findings There is a prominent amount of edema of the medial aspect of the ankle with an abnormal relationship on the coronal sequence where the posterior tibial tendon (PTT) is medial to the medial malleolus. Subsequent axial and coronal images demonstrate an anterior/medial position of the posterior tibial tendon, fluid/debris of the PTT tendon sheath, and disruption of the flexor retinaculum.
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What’s the Diagnosis – Case 144
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Diagnosis: Posterior Tibial Tendon (PTT) Dislocation A rare entity and one that can frequently go with a prolonged delay in diagnosis given the rarity of the entity. As in this case there is frequently a disruption of the flexor retinaculum running from the medial malleolus to the calcaneus which allows a medial and anterior dislocation of the PTT. At times the retinaculum is stripped and other times lax, but by in large it is disrupted. Also as seen in this case is that the posterior groove of the distal tibia for the PTT can be shallow giving a proclivity for this still rare event. As in this case operative treatment was mandated. The surgery performed varies with most frequently repair/augmentation of the flexor retinaculum and a deepening of the groove for the PTT being performed.
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References Dislocation of the Posterior Tibial Tendon: A Literature Review and Presentation of Two Cases. Nicholas R Goucher, MD, Michael J Coughlin, MD, and Ronald M Kristensen, MD. Iowa Orthop J. 2006; 26: 122–126. Tibialis Posterior Tendon Dislocation: A Review and Suggested Classification. Strydom A, Saragas NP, Tladi M, Ferrao PNF. J Foot Ankle Surg. 2017 May Jun;56(3):656-665. doi: 10.1053/j.jfas.2017.01.006. Epub 2017 Feb 22.
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