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Skeletal Radiology

, Volume 37, Issue 9, pp 849–855 | Cite as

Complex distal insertions of the tibialis posterior tendon: detailed anatomic and MR imaging investigation in cadavers

  • Daniel Pastore
  • Berna Dirim
  • Mani Wangwinyuvirat
  • Clarissa L. Belentani
  • Parviz Haghighi
  • Debra J. Trudell
  • Giovanni G. Cerri
  • Donald L. Resnick
Scientific Article

Abstract

Purpose

The purpose of this report was to demonstrate the normal complex insertional anatomy of the tibialis posterior tendon (TPT) in cadavers using magnetic resonance (MR) imaging with anatomic and histologic correlation.

Material and methods

Ten cadaveric ankles were used according to institutional guidelines. MR T1-weighted spin echo imaging was performed to demonstrate aspects of the complex anatomic distal insertions of the TPT in cadaveric specimens. Findings on MR imaging were correlated with those derived from anatomic and histologic study.

Results

Generally, the TPT revealed a low signal in all MR images, except near the level of the medial malleolus, where the TPT suddenly changed direction and “magic angle” artifact could be observed. In five out of ten specimens (50%), a type I accessory navicular bone was found in the TPT. In all cases with a type I accessory navicular bone, the TPT had an altered signal in this area. Axial and coronal planes on MR imaging were the best in identifying the distal insertions of the TPT. A normal division of the TPT was observed just proximal to the insertion into the navicular bone in five specimens (100%) occurring at a maximum proximal distance from its attachment to the navicular bone of approximately 1.5 to 2 cm. In the other five specimens, in which a type I accessory navicular bone was present, the TPT directly inserted into the accessory bone and a slip less than 1.5 mm in thickness could be observed attaching to the medial aspect of the navicular bone (100%). Anatomic inspection confirmed the sites of the distal insertions of the components of the TPT.

Conclusion

MR imaging enabled detailed analysis of the complex distal insertions of the TPT as well as a better understanding of those features of its insertion that can simulate a lesion.

Keywords

Tibialis posterior tendon MR imaging Anatomy Histology 

References

  1. 1.
    Blake RL, Anderson K, Ferguson H. Tibialis posterior tendonitis: a literature review with case reports. JAPMA 1994; 84: 141–149.Google Scholar
  2. 2.
    Kaye RA, Jahss MH. Tibialis posterior: a review of anatomy and biomechanics in relation to support of the medial longitudinal arch. Foot Ankle 1991; 11: 244–247.PubMedGoogle Scholar
  3. 3.
    Schweitzer ME, Caccese R, Karasick D, Wapner KL, Mitchell DG. Tibialis posterior tendon tears: utility of secondary signs for MR imaging diagnosis. Radiology 1993; 188: 655–659.PubMedGoogle Scholar
  4. 4.
    Conti S, Michelson J, Jahss M. Clinical significance of magnetic resonance imaging in preoperative planning for reconstruction of tibialis posterior tendon ruptures. Foot Ankle 1992; 13: 208–214.PubMedGoogle Scholar
  5. 5.
    Pomeroy GC, Pike RH, Beals TC, Manoli A. Acquired flatfoot in adults due to dysfunction of the tibialis posterior tendon. J Bone Joint Surg 1999; 81: 1173–1182.PubMedGoogle Scholar
  6. 6.
    Morgan J, Benard MA, Smith S, Rhodes SD, Meis CM, Hambrecht S. Use of tensor fascia lata in the correction of tibialis posterior tendon dysfunction. Lower Extremity 1997; 4: 7–16.Google Scholar
  7. 7.
    Myerson MS. Adult acquired flatfoot deformity. J Bone Join Surg 1996; 78: 780–792.Google Scholar
  8. 8.
    Mann RA. Biomechanics of the foot. In: American Academy of Orthopaedic Surgeons, editor. Atlas of orthotics: biomechanical principles and application. St. Louis: C. V. Mosby; 1975: 264.Google Scholar
  9. 9.
    Mann RA. Flatfoot in adults. In: Mann RA, Coughlin MJ, editors. Surgery of the foot and ankle. St. Louis: C. V. Mosby; 1993: 757–784.Google Scholar
  10. 10.
    Sarrafian SK. Anatomy of the foot and ankle. Philadelphia: JB Lippincott; 1983: 216–219.Google Scholar
  11. 11.
    Kiter E, Erdag N, Karatosun V, Günal I. Tibialis posterior tendon abnormalities in feet with accessory bone and flatfoot. Acta Orthop Scand 1999; 70: 618–621.PubMedCrossRefGoogle Scholar
  12. 12.
    Kiter E, Günal I, Karatosun V, Korman E. The relationship between the tibialis posterior tendon and the accessory navicular. Ann Anat 2000; 182: 65–68.PubMedCrossRefGoogle Scholar
  13. 13.
    Bareither DJ, Muehleman CM, Feldman NJ. Os tibiale externum or sesamoid in the tendon of tibialis posterior. J Foot Ankle Surg 1995; 34: 429–434.PubMedGoogle Scholar
  14. 14.
    Grogan DP, Gasser SI, Ogden JA. The painful accessory navicular: a clinical and histopathological study. Foot Ankle 1999; 10: 164–169.Google Scholar
  15. 15.
    Chen YJ, Hsu RWW, Liang SC. Degeneration of the accessory navicular synchondrosis presenting as rupture of the tibialis posterior tendon. J Bone Joint Surg 1997; 79: 1791–1798.PubMedGoogle Scholar
  16. 16.
    Fernandes R, Aguiar R, Trudell D, Resnick D. Tendons in the plantar aspect of the foot: MR imaging and anatomic correlation in cadavers. Skeletal Radiol 2007; 36: 115–122.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2008

Authors and Affiliations

  • Daniel Pastore
    • 1
    • 2
    • 4
  • Berna Dirim
    • 2
  • Mani Wangwinyuvirat
    • 2
  • Clarissa L. Belentani
    • 2
  • Parviz Haghighi
    • 2
    • 3
  • Debra J. Trudell
    • 2
  • Giovanni G. Cerri
    • 1
    • 2
  • Donald L. Resnick
    • 2
  1. 1.Department of RadiologyUniversity of São PauloSão PauloBrazil
  2. 2.Department of RadiologyVA Medical Center, University of CaliforniaSan DiegoUSA
  3. 3.Department of HistologyVA Medical Center, University of CaliforniaSan DiegoUSA
  4. 4.São PauloBrazil

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