48-year-old male with medial ankle pain and pain with bearing weight since crushing injury. Evaluate for posterior tibial tendon rupture/injury. TENDONS: There is a circumferential fluid about the posterior tibialis tendon which is suspicious for tenosynovitis. There is also fluid about the flexor digitorum longus tendon also suggestive of tenosynovitis. The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is within normal limits.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. There is increased signal abnormality and thickening of the deep layer of the deltoid ligament.ARTICULAR SURFACES AND BONE: There is increase signal abnormality in the medial malleolus and medial aspect of the talar dome likely representing reactive osteitis secondary to the aforementioned tenosynovitis. There is mild narrowing of the medial aspect of the tibiotalar joint with associated subchondral cyst formation in the medial malleolus suggestive of degenerative changes. There is a benign appearing focal lesion in the posterior aspect of the distal tibial metadiaphysis, incompletely imaged, most consistent with a healing nonossifying fibroma.ADDITIONAL
1. Findings suggestive of posterior tibialis tendon tenosynovitis and associated reactive osteitis of the underlying bone.2. Chronic appearing changes of the deep layer of the deltoid ligament which may represent prior trauma. Other findings as described above. 