Complex distal insertions of the tibialis posterior tendon: detailed anatomic and MR imaging investigation in cadavers
- 341 Downloads
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.
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.
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.
KeywordsTibialis posterior tendon MR imaging Anatomy Histology
- 1.Blake RL, Anderson K, Ferguson H. Tibialis posterior tendonitis: a literature review with case reports. JAPMA 1994; 84: 141–149.Google Scholar
- 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.Myerson MS. Adult acquired flatfoot deformity. J Bone Join Surg 1996; 78: 780–792.Google Scholar
- 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.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.Sarrafian SK. Anatomy of the foot and ankle. Philadelphia: JB Lippincott; 1983: 216–219.Google Scholar
- 14.Grogan DP, Gasser SI, Ogden JA. The painful accessory navicular: a clinical and histopathological study. Foot Ankle 1999; 10: 164–169.Google Scholar