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Monday, February 13, 2012

Posterior Tibial Tendon Tear: MRI images

One of my patients recently tore his posterior tibial tendon, the most important ankle tendon for arch support. He is being worked up for surgery and I thought his MRI images may be helpful to some of you suffering from Posterior Tibial Tendon problems.

The 3 medial ankle tendons that go into the foot are: flexor hallucis longus  (FHL), flexor digitorum longus (FDL), and the posterior tibial tendon (PT). See the solid dark circles that make up the FHL and FDL. See the white area where the posterior tibial tendon should be.

The FHL and FDL are well visualized. The medial or inside ankle bone shows old bone chips from a fracture 20 years ago by the sensor.

As we get further into the foot with our imaging, the area of the posterior tibial tendon is more blown-out than the FHL or FDL. Good, solid, tendons should look dark, condense, and have sharp borders. The PT has none of this.

Further imaging into the foot shows the PT tendon non-compact and almost stretched.

This side view of the ankle shows a solid FDL tendon as it comes down into the foot, and an almost nonexistent Posterior Tibial Tendon. 
This is such an important tendon in the body that I am forced to send to the surgeons for repair. Hopefully, once the surgical part is done, I can begin the often 2 years of gradual rehabilitation for full strength.


  1. I did have this problem and the ensuing surgical repair, age 53, and it truly did take 18-24 months to rehabilitate. It was incredibly painful. Now my other foot is degenerating in the same way, age 61.

    1. Thank you for your comment. I find the pain level varies from patient to patient, but the length of time of 2 years pretty standard. Try to protect your other foot with good orthotics, stable shoes, ankle braces like the Aircast Airlift PTTD when appropriate, and great posterior tibial tendon strengthening exercises. It is a problem that does affect both sides, so get the other side as strong as possible. Dr Rich Blake

  2. I was recently seen by an orthopedist who determined I had Posterior Tibial Tendonitis that may have gotten worse and now have an arch collapse, by that I mean looking at my foot, there is absolutley no arch. I have some of the symptoms, esp pain on my inner ankle and foot. Also, I am unable to perform the toe raise on the affected foot without causing quite a bit of pain, or not able to perform it at all. I was prescribed a walking boot but I still have a considerable amount of pain with it on. They performed an MRI of just my foot and I am to visit a foot/ankle specialist this upcoming Monday. Should they have taken an MRI of my ankle too? I knew they were concerned about my posterior tendon, but there was no mention of it in the MRI report. I am just a little concerned at the moment. I am currently working as a nurse in an ICU and they put me on sit-down only work restriction so as not to make the injury an worse. Any advice? Thanks!

    1. This sounds like Posterior Tibial Tendon Dysfunction and unfortunately they may have to consider surgical repair (but see what the MRI shows). If the foot MRI did not get the area enough, the ortho will have to get another. Your job is to control the swelling with icing every 2 hours or so, compression of some sort 24/7, and as much elevation as possible (even as little as 2 inches off the floor). Does not sound like it can take the pressure from a Aircast PTTD Airlift Brace. Just rest as much as you can. You have to have torn the tendon to produce the changes on your foot. I hope this helps some. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.