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MR Imaging Findings of Entrapment of the Flexor Hallucis Longus Tendon

Lawrence D. Lo1,2, Mark E. Schweitzer1, Jennifer K. Fan1, Keith L. Wapner3 and Paul J. Hecht3

1 Department of Radiology, Thomas Jefferson University Hospital, 111 S. 11th St., Rm. 3350 G, Philadelphia, PA 19107.
2 Present address: Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce St., Philadelphia, PA 19104.
3 Department of Orthopedic Surgery, Pennsylvania Hospital, 800 Spruce St., Philadelphia, PA 19107.



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  		Fig. 1. —38-year-old woman with posteromedial ankle pain. Sagittal fast short T1 inversion recovery image (TR/TE, 4000/39; 160 msec) shows enlarged os trigonumtarsi (open arrow) with loculated fluid in flexor hallucis longus tendon sheath (solid arrow) proximal to os. Flexor hallucis longus tendon was normal (not shown).

 


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  		Fig. 2. —33-year-old man with loss of full range of plantar flexion after calcaneal fracture. Axial fast spin-echo MR image (TR/TE, 4300/75) shows osseous fragments (solid arrows) impinging on flexor hallucis longus tendon (open arrow).

 


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  		Fig. 3A. —27-year-old man with clawing of great toe after penetrating injury. Axial proton density—weighted MR image (TR/TE, 4000/40) shows scarring (arrow) at myotendinous junction of flexor hallucis longus tendon 1 cm above talar dome.

 


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  		Fig. 3B. —27-year-old man with clawing of great toe after penetrating injury. Axial fat-suppressed fast spinecho MR image (6000/90) at same level as A shows scarring and small fluid collection (arrow) in flexor hallucis longus tendon muscle belly.

 


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  		Fig. 4A. —45-year-old woman with posterior ankle pain. Axial fat-suppressed fast spin-echo MR image (TR/TE, 6000/90) reveals loculated fluid (arrow) in flexor hallucis longus tendon sheath surrounding normal flexor hallucis longus tendon.

 


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  		Fig. 4B. —45-year-old woman with posterior ankle pain. MR image inferior to A shows enlarged os trigonumtarsi (thin arrow) with adjacent cystic changes in talus (thick arrow) suggestive of altered biomechanics. There is abrupt change in amount of fluid in flexor hallucis longus tendon sheath at level of os.

 

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