Posterior Tibial Tendon Longitudinal Split Tear

Left Image: Longitudinal sonogram of the medial ankle reveals a cleft (yellow shade/arrows) within the substance of the posterior tibial tendon (red shade/arrows) in the region of the medial malleolus.

Right Image: Corresponding longitudinal transducer position technique.

Left Image: Transverse sonogram of the medial ankle shows the posterior tibial tendon (red outline) with a curvilinear hypoechoic defect (yellow line/arrow) representing the proximal aspect of the longitudinal split tear.

Right Image: Corresponding transverse transducer position technique.
Left Image: Transverse sonograms of the posterior tibial tendon (red outline) again shows the longitudinal split tear (yellow shade/arrow).

Right Image: Longitudinal sonogram with power Doppler demonstrates increased flow within and surrounding the tendon consistent with inflammation.
Left and Right Images: Axial PD-weighted MRI images shows deformity of the posterior tibial tendon with abnormal internal signal representing the longitudinal split tear (yellow shade/arrow). Note the flexor digitorum longus tendon (red arrow) and the flexor hallucis longus tendon (blue arrow). [Overlay is magnified and coned down]