The anterior tibial tendon (ATT) originates from the lateral tibia and the anterior aspect of the interosseous tibiofibular ligament, and inserts onto the medial cuneiform and base of the first metatarsal. The ATT (Fig. 37) acts to dorsiflex and invert the foot. The extensor hallucis longus tendon originates from the medial fibula and interosseous ligament, and inserts onto the base of the great
Fig. 43. Disruption of the interosseous ligament after severe ankle sprain (arrow). (Courtesy of Department of MRI, Hospital for Special Surgery, New York, NY.)
toe distal phalanx, acting to dorsiflex and extend the great toe. The extensor digitorum longus originates from the lateral tibia and proximal fibula, and inserts onto the dorsal base of the middle and distal phalanges of the second through fifth toes, acting to dorsiflex and extend the toes. Injury to the ATT, EHL, and EDL are uncommon, occurring after laceration to the dorsum of the foot, or acute forced plantarflexion of the toes [82,83]. MRI appearance of extensor tendon injury includes thickening, increased or inhomogeneous signal intensity, or disruption (Fig. 38) . ATT tendon injury usually occurs within 3 cm of its insertion . Surgical repair is typically performed after tendon rupture, and may include end-to-end anastomosis or tendon transfer for augmentation [83,85].
Fig. 44. Lobulated ganglion in the sinus tarsi (arrow).
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