37-year-old female with pain. Evaluate for chronic tibialis posterior tendinitis/possible tear. TENDONS: There is thickening and increased signal abnormality within the tibialis posterior tendon at the level of the distal tip of the medial malleolus indicating moderate tendinosis. There is increased fluid signal abnormality and deformity within the distal tendon consistent with a longitudinal split tear. There is circumferential fluid within the tendon sheath of the flexor hallucis longus which may represent fluid extension from the joint space versus a tenosynovitis. The peroneal tendons appear intact. The extensor tendons appear intact. The Achilles tendon is normal in appearance. LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The image components of the deltoid ligament appear intact. The cervical ligament and the interosseous talocalcaneal ligament are poorly visualized secondary to subtalar joint fluid.ARTICULAR SURFACES AND BONE: There is increased signal abnormality within the medial malleolus which may be related to the aforementioned posterior tibialis tendinosis. No other bone marrow signal abnormality is identified. ADDITIONAL
1. Tibialis posterior tendinosis and longitudinal split tear as described above. There is associated reactive osteitis within the medial malleolus.2. Subtalar joint effusion with circumferential fluid within the tendon sheaths of flexor tendons which may represent fluid extension from the joint versus a tenosynovitis.