79-year-old female with history of chronic ankle pain. TENDONS: There is fusiform thickening of the Achilles' tendon compatible with moderate tendinosis. Signal abnormality within Kager's fat pad likely represents edema and scarring. There is extensive tearing of the tibialis posterior tendon including a large longitudinal tear that extends along nearly the entire length of the visualized tendon as well as from the anterior surface to the posterior surface indicating a complete longitudinal tear. The tibialis posterior tendon is markedly thinned posterior to the medial malleolus, but we see no full-thickness transverse rupture at this time. There is thickening of the tendon at its insertion. There is a small amount of fluid within the flexor hallucis longus tendon sheath posterior to the talus as well as proximal and distal to the knot of Henry which may represent tenosynovitis. The peroneal tendons appear intact. There is a small amount of fluid adjacent to the tibialis anterior tendon as it courses anterior to the distal tibia indicating mild tenosynovitis.LIGAMENTS: The anterior talofibular ligament is thinned, but otherwise intact. The calcaneofibular and posterior talofibular ligaments are intact. The distal syndesmotic ligaments are unremarkable. The visualized portions of the deltoid ligament are intact. The spring ligament is thickened, but there is no discrete tear identified.ARTICULAR SURFACES AND BONE: There is multifocal bone marrow edema within the head, neck, and body of the talus, the medial aspect of the tibial plafond, the anterior aspect of the distal fibula, and the anterior process of the calcaneus. This finding is nonspecific and may be degenerative in etiology, represent a stress reaction or bone contusion, or a combination of the above. There is a small amount of fluid within the tibiotalar and talonavicular joints, which is nonspecific. There is mild diffuse edema of the subcutaneous fat around the ankle. Signal abnormality within the heel pad is also nonspecific but may represent callus, although we see no signal abnormality in the underlying bone to suggest acute osteomyelitis. Mild osteoarthritis affects the ankle and midfoot.
1.Soft tissue swelling with extensive tearing of the tibialis posterior tendon and mild tendinosis of the Achilles' tendon as well as findings compatible with tenosynovitis of the tibialis anterior and flexor hallucis longus tendons.2.Mild thickening of the spring ligament, but the fibers appear intact.3.Multiple foci of bone marrow edema type signal which are nonspecific and may be degenerative in etiology or represent bone contusions/stress reactions or a combination of the above.4.Mild osteoarthritis and other findings as above.