Sonography is effective in diagnosing tendinopathy, tenosynovitis, and partial and complete tears of the posterior tibialis tendon (PTT) [24,41,55]. When compared with MRI, the sensitivity and specificity of sonography for diagnosing tendinopathy were 80% and 90% respectively, and for diagnosing periten-dinopathy, were 90% and 80% . The study by Gerling and colleagues , showed that sonography and MRI had a similar overall accuracy in evaluating surgically created longitudinal PTT tears, but that sonography has a higher specificity when compared with MRI. Dynamic sonography with scanning while stressing the tendon demonstrated 69% sensitivity, 81% specificity, and 72% accuracy in comparison with a 73% sensitivity, 69% specificity, and 72% accuracy for MRI. Static sonography was less reliable than dynamic stressing of the tendon . The recent study by Nallamshetty and coworkers 
found that sonography and MRI of in a series of patients who had PTT pathology had a high concordance. Although sonography was slightly less sensitive than MRI for PTT pathology, the discrepancies did not affect clinical management. The authors believe that sonography offers a more convenient and less expensive alternative to MRI for detecting posterior tibialis tendon pathology.
The sonographic findings of tendinopathy on ultrasound are a thickened tendon, flow within the tendon on power Doppler, and inhomogeneity of the tendon (Fig. 21) . A complete tear is seen as disruption of tendon fibers, with the gap filled in by hematoma . Tenosynovitis is seen as fluid surrounding the tendon with peritendinous flow on Doppler (Fig. 22). Partial tears of the tendon appear as a linear hypoechoic area within the substance of the tendon, which extends to the periphery of the tendon (Fig. 23) [58,59].
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