The tibialis posterior tendon originates from the interosseous membrane and posterior portion of the tibia and fibula and inserts on multiple locations including the navicular, cuneiform, cuboid, and second, third, and...
The tibialis posterior tendon originates from the interosseous membrane and posterior portion of the tibia and fibula and inserts on multiple locations including the navicular, cuneiform, cuboid, and second, third, and fourth metatarsal base. On its course distal, the posterior tibialis tendon will be the most superficial structure at the level of the posterior medial malleolus. The tendon will travel through a fibro-osseous tunnel that lies deep to the flexor retinaculum.
During an ankle injury, the tunnel and flexor retinaculum can become torn, allowing the tendon to travel anteriorly. These injuries are categorized as either a type 1 injury, which is a dislocation due to anterior retinaculum flexor rupture, or type 2, which involves subperiosteal dislocation with tibialis posterior flap. Image on the left is normal tendon anatomy, middle image is subcutaneous dislocation, and image on the right shows subperiosteal dislocation Traumatic dislocation of the tibialis posterior tendon is not commonly seen and can be difficult to diagnose.
It is more commonly seen in younger adults. Patients will typically complain of an injury where they had an inverted foot that was plantarflexed or dorsiflexed and then experienced a strong posterior tibial tendon contraction. It is not uncommon for the patient to have felt a “pop” in the ankle or to experience recurrent “snapping” after the injury.
The diagnosis may be missed initially and patients will present with prolonged medial ankle pain after ankle injury. Having a shallow retromalleolar groove is a risk factor for tendon dislocation. Physical examination of the ankle will sometimes show a palpable tendon overlying the anterior portion of the tibia.
There may also be medial ankle edema and ecchymosis. Standard radiographs are typically normal. However, dynamic ultrasound can also be done to try and provoke the tendon dislocation.
If you are experiencing symptoms that may be related to posterior tibial tendon dislocation, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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