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Association of Posterior Tibial Tendon Injury with Spring Ligament Injury, Sinus Tarsi Abnormality, and Plantar Fasciitis on MR Imaging

¹ Both authors: Department of Radiology, P. O. Box 3808, Duke University Medical Center, Durham, NC 27710.

View larger version (125K): [in a new window]   Fig. 1. —Normal spring ligament in 25-year-old man with normal ankle. Axial fast spin-echo T2-weighted image (TR/TE, 4000/74) at level of the talus shows normal spring ligament (straight arrows) just deep in relation to a normal posterior tibial tendon (curved arrow).

View larger version (152K): [in a new window]   Fig. 2. —Normal sinus tarsi in 30-year-old woman with normal ankle. Sagittal T1-weighted image (TR/TE, 700/15) through normal sinus tarsi shows fat-filled space with cervical ligament (arrow) running through it.

View larger version (113K): [in a new window]   Fig. 3A. —68-year-old woman with posterior tibial tendon tear and associated abnormality of spring ligament. Axial T1-weighted MR image (TR/TE, 700/15) shows thickening of spring ligament (open arrows) with increased signal in central portion. Markedly attenuated posterior tibial tendon (solid arrow) is just superficial to spring ligament.

View larger version (163K): [in a new window]   Fig. 3B. —68-year-old woman with posterior tibial tendon tear and associated abnormality of spring ligament. Coronal proton density-weighted MR image (1800/16) reveals posterior tibial tendon (solid straight arrows) lying just superficial to thickened spring ligament (open straight arrows). Spring ligament is superiorly contiguous with deltoid ligament (curved arrow).

View larger version (189K): [in a new window]   Fig. 4A. —54-year-old woman with posterior tibial tendon tear and associated abnormality of spring ligament. Axial fast spin-echo T2-weighted image (TR/TE, 4050/70) shows thickened spring ligament (straight arrows). Thickened posterior tibial tendon (curved arrow) with increased signal lies just superficial to spring ligament.

View larger version (190K): [in a new window]   Fig. 4B. —54-year-old woman with posterior tibial tendon tear and associated abnormality of spring ligament. Coronal fast spin-echo T2-weighted image (4050/70) reveals posterior tibial tendon (solid arrows) just superficial to abnormally thickened spring ligament (open arrows). Spring ligament is superiorly contiguous with deltoid ligament (curved arrow).

View larger version (180K): [in a new window]   Fig. 5A. —45-year-old woman with tear of posterior tibial tendon and associated abnormality of sinus tarsi. Axial fast spin-echo T2-weighted image (TR/TE, 4050/83) shows thickened spring ligament (open arrow). Markedly attenuated posterior tibial tendon (solid arrow) is seen just superficial to spring ligament.

View larger version (133K): [in a new window]   Fig. 6A. —58-year-old woman with posterior tibial tendon tear and associated abnormality of spring ligament, sinus tarsi, and plantar fascia. Axial fast spin-echo T2-weighted image (TR/TE, 4000/74) reveals multiple split tears of posterior tibial tendon (arrow). Lower images show abnormality of spring ligament. Note edema in fibula (F) of unknown cause.

View larger version (147K): [in a new window]   Fig. 5B. —45-year-old woman with tear of posterior tibial tendon and associated abnormality of sinus tarsi. Sagittal T1-weighted image (650/10) reveals replacement of normal fat within sinus tarsi (arrow).

View larger version (128K): [in a new window]   Fig. 6C. —58-year-old woman with posterior tibial tendon tear and associated abnormality of spring ligament, sinus tarsi, and plantar fascia. Sagittal T1-weighted image (500/10) shows replacement of normal fat signal within sinus tarsi (arrow).

View larger version (133K): [in a new window]   Fig. 6D. —58-year-old woman with posterior tibial tendon tear and associated abnormality of spring ligament, sinus tarsi, and plantar fascia. Sagittal fast spin-echo T2-weighted image (4000/74) reveals thickening of plantar fascia (arrow) with adjacent edema.

View larger version (147K): [in a new window]   Fig. 6E. —58-year-old woman with posterior tibial tendon tear and associated abnormality of spring ligament, sinus tarsi, and plantar fascia. Coronal fast spin-echo T2-weighted image (4000/74) shows thickened central cord of plantar fascia with adjacent edema (arrow).

View larger version (131K): [in a new window]   Fig. 7A. —40-year-old woman with posterior tibial tendon tear and associated abnormality of plantar fascia. Sagittal fast spin-echo T2-weighted image (TR/TE, 4000/75) shows thickened plantar fascia (arrow) with adjacent edema. Plantar flexion of talus (T) on calcaneus (C) is also present resulting in hindfoot valgus deformity.

View larger version (163K): [in a new window]   Fig. 7B. —40-year-old woman with posterior tibial tendon tear and associated abnormality of plantar fascia. Coronal fast spin-echo T2-weighted image (3100/68) reveals thickening of medial band of plantar fascia (arrow) with adjacent edema.

View larger version (158K): [in a new window]   Fig. 6B. —58-year-old woman with posterior tibial tendon tear and associated abnormality of spring ligament, sinus tarsi, and plantar fascia. Coronal fast spin-echo T2-weighted image (4000/74) shows thickening of spring ligament (arrows).

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