Pain, edema with medial ankle shift left and indistinct cortex to medial talus. Evaluate for Charcot versus septic ankle joint versus DJD. The posterior tibialis tendon is not visible posterior to the tip of the medial malleolus, indicating a complete rupture. More proximally, the tendon is markedly enlarged with increased intrasubstance signal extending to the tendinous surface indicating tendinosis and partial-thickness tearing. The distal segment of the torn tendon, extending from the tip of the medial malleolus to the navicular tuberosity, is enlarged and deformed, with increased signal intensity indicating severe tendinosis and partial-thickness tearing. There is enhancement of the soft tissues at the site of the tear extending both proximally and distally along the abnormal tendon, indicating inflammation. The adjacent flexor digitorum longus tendon appears intact, as does the flexor hallucis longus tendon. The peroneal tendons appear intact, as do the anterior tendons and the Achilles tendon.Mild osteoarthritis affects the tibiotalar joint with small subchondral cysts. There is a small amount of fluid within the joint, but no large effusion, and I see no findings to suggest a septic arthritis. A small amount of fluid within the subtalar joint is likewise within normal limits. Mild to moderate osteoarthritis affects the midfoot articulations, but I see no specific imaging features of neuropathic arthropathy. Small ossicles distal to the medial malleolus may reflect old trauma. Please note that this protocol was not optimized for evaluation of the ligaments of the ankle.
1. Complete rupture of the posterior tibialis tendon with severe tendinosis and additional partial thickness tearing of the tendon as described above.2. Osteoarthritis and other findings as described above.