Flexor Tendons

The flexor tendons that will be discussed in this setting are the posterior tibial tendon (PIT), the flexor digitorum longus tendon (FDL), and the flexor

Peroneus Longus And Brevis Mri

Fig. 22. Peroneal tendon subluxation. Axial image demonstrates the peroneus longus and brevis tendons lateral to the fibular tip. (Courtesy of Department of MRI, Hospital for Special Surgery, New York, NY.)

Mri Split Peroneus Brevis Tendon

Fig. 23. Longitudinal split of the peroneus brevis tendon (arrow) gives appearance of three peroneal tendons.

hallucis longus tendon (FHL) (Fig. 27). The PIT originates from the posterior aspect of the interosseous tibiofibular ligament, the tibia, and the fibula, and inserts onto the navicular tuberosity, each of the cuneiforms, and the second through fourth metatarsals. Additional sites of PTT insertion have been found on the spring ligament, the fifth metatarsal base, the flexor hallucis brevis, and the peroneus longus tendon [63]. When present, an accessory navicular serves as a site of PTT insertion [64]. An accessory navicular is commonly associated

Peroneus Brevis Tendon Inflammation
Fig. 24. Axial FSE image demonstrates longitudinal split in the peroneus longus tendon. Peroneus brevis is also degenerated.
Peroneals Tendon Tear Mri

Fig. 25. Enlarged peroneal tubercle in a patient with peroneus longus and brevis tendon tears. (Courtesy of Department of MRI, Hospital for Special Surgery, New York, NY.)

with PTT tendinosis, and often demonstrates increased signal intensity within the accessory navicular and synchondrosis (Fig. 28), correlating at histology with areas of necrosis, granulomatous inflammation, fibrosis, and destruction of the cartilage cap [65]. In ambulation, the PTT functions to shift the center of pressure anteriorly, and PTT insufficiency causes abnormal loading posteriorly in the foot, suggesting a biomechanical reason why PTT dysfunction leads to acquired flatfoot deformity [66]. PTT injury or tendinosis occurs most

Mri Peroneal Tendon
Fig. 26. Scarring of the superior peroneal retinaculum from previous surgical reconstruction of the retinaculum, with tethering of the peroneal tendon sheath (white arroW) and sural nerve (black arrow). (Courtesy of Department of MRI, Hospital for Special Surgery, New York, NY.)
Mri Images Peroneal Nerve Tears

Fig. 27. Axial FSE image demonstrates an incidental peroneus quartus muscle (arrow).

commonly in the retromalleolar region, where the tendon changes its direction of pull [67]. MRI appearance of tendinosis includes tendon thickening and increased signal intensity (Fig. 29). Partial tear appears as thickening and an in-homogeneous appearance, with partial disruption of fibers or a longitudinal split, and complete tear is manifested as disruption of fibers and a wavy appearance (Fig. 30). Surgical repair of the PTT may include end-to-end anastomosis or side-to-side augmentation with the FDL tendon, often performed in

Stress Fracture

Fig. 28. Axial FSE image demonstrates normal posterior tibial tendon (large white arrow), flexor digitorum longus tendon (black arrow), and flexor hallucis longus tendon (small white arrow).

Navicular Accessory Bone Mri
Fig. 29. Axial FSE image demonstrates an accessory navicular. Sagittal STIR image demonstrates marrow edema pattern on both sides of the synchondrosis.

conjunction with a distal calcaneal osteotomy and lateral column lengthening procedure [68]. Tenosynovitis of the PTT may result from local mechanical factors or overuse, seronegative spondyloarthropathies, or rheumatoid arthritis [69]. On MRI, tenosynovitis is manifested as fluid within the tendon sheath, with or without abnormal signal or morphology of the tendon. Initial treatment usually includes rest and anti-inflammatory medications, although surgical debridement may be performed in the first 6 weeks in the setting of seronegative disease [69].

Calcaneal Stress Fracture

Fig. 30. Axial FSE image demonstrates thickening and increased signal intensity of the posterior tibial tendon. Tendinosis.

Distal Posterior Tibial
Fig. 31. (A) Empty posterior tibial tendon sheath (arrow). (B) Inhomogeneous, wavy appearance of the distal PTT tendon (arrow). (Courtesy of Department of MRI, Hospital for Special Surgery, New York, NY.)

The FDL originates from the posterior tibia and inserts onto the bases of the distal phalanges of the second through fifth toes. The FDL acts to plantarflex the lateral four toes. The FHL originates from the posterior fibula, courses between the lateral and medial tubercles of the posterior talar process (Fig. 27), through a groove at the plantar aspect of the sustentaculum tali, and inserts onto the base of the great toe distal phalanx. The FHL acts to plantarflex the great toe. The anatomic crossover of the FDL and FHL tendons, called

Knot Henry
Fig. 32. Normal crossover of the FDL and FHL tendons (Knot of Henry).

Fig. 33. Axial FSE image demonstrates the posterior tibial artery and vein, and tibial nerve at the posteromedial ankle, between the FDL and FHL tendons.

the Knot of Henry (Fig. 31), demonstrates tendinous interconnections between the two tendons [70]. As a result, tension applied to the FHL proximal to the Knot of Henry causes flexion of all digits plus the great toe [71]. This interconnection allows surgical transaction of the FDL to be performed proximal to the Knot of Henry for PTT augmentation or other tendon transfer procedure, while still retaining flexion of all digits [71]. As with other tendons, a wide range of sports-related disorders of the flexor tendons may be seen, including tendi-nosis, partial or complete tear, tenosynovitis, tethering, or ossification. A small amount of fluid may be seen within the FHL tendon sheath of asymptomatic

Fhl Tendon TransferAccessory Soleus

Fig. 34. Axial images demonstrate an accessory soleus (white arrows). The location of the tibial nerve (black arrows) between the accessory soleus and the FHL (A) or the medial tubercle (B) make it susceptible to compression.

Posterior Capsule Ankle

Fig. 35. Prominent scarring at the posterior ankle and hypertrophic osteophyte from the medial tubercle cause compression (arrows) of the tibial nerve. The FHL tendon sheath and posterior capsule demonstrate increased signal intensity and an inhomogeneous appearance. (Courtesy of Department of MRI, Hospital for Special Surgery, New York, NY.)

Fig. 35. Prominent scarring at the posterior ankle and hypertrophic osteophyte from the medial tubercle cause compression (arrows) of the tibial nerve. The FHL tendon sheath and posterior capsule demonstrate increased signal intensity and an inhomogeneous appearance. (Courtesy of Department of MRI, Hospital for Special Surgery, New York, NY.)

patients (Fig. 27) [72]. Similar to the PTT, tenosynovitis of the FDL or FHL tendons is manifested as fluid within the tendon sheath with or without tendon abnormality. Similar to the peroneal tendons (Fig. 25), tethering of the tendon may result from fractures, or from scarring of the tendon sheath or retinaculum after trauma or surgery.

Tenosynovitis Fdl
Fig. 36. The normal course of the medial (black arrows) and lateral (white arrows) plantar nerves.
Mri Image Peroneus Brevis Tendon
Fig. 37. Sagittal STIR and FSE images demonstrate an os trigonum with associated marrow and surrounding soft tissue edema (white arrow), and mild FHL tendinosis (black arrow).

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Responses

  • Sanna
    Is peroneus brevis a flexor tendon?
    7 years ago
  • FEORIE
    What is tendon tethering?
    7 years ago
  • elanor
    Are peroneal tendons flexor tendons?
    7 years ago
  • tommy
    What is fluid in peroneal and posterior tibal tendon sheaths?
    7 years ago

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