posterior tibial tendon ( RID3194 )
There is posterior tibial tendinosis and tenosynovitis with prominent smooth erosion and reactive bone marrow edema at the posterior medial distal tibia and medial malleolus. The overlying flexor retinaculum is frayed with surrounding and overlying subcutaneous edema, but doesnt appear torn or stripped. The PTT is located on this static exam. Ive read that there may be medial malleolar erosion with (rare) medial dislocation of the PTT, but that doesnt seem to be the case here. Ive posted erosion with adjacent tenosynovitis in the wrist and presume its the same here. I wonder if its chronic pressure erosion, or if its somehow related to osteoclasts at the interface of the inflamed tenosynovium and underlying bone. The article focuses on RA (this patient has no known history) but I thought the discussion about evolution of erosions is interesting [ Article ]

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