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AI-powered posterior tibial tendon dysfunction detection on ankle MRI. Assess tendon degeneration, tears, and associated flatfoot deformity. 4 AI models evaluate tendon morphology and spring ligament integrity.
Posterior tibial tendon dysfunction (PTTD) is the most common cause of acquired adult flatfoot deformity. The posterior tibial tendon supports the medial longitudinal arch and controls hindfoot inversion during gait. When the tendon degenerates, it progressively elongates and loses its mechanical advantage, leading to arch collapse and hindfoot valgus. PTTD is staged from I to IV: Stage I involves tendinopathy with a normal arch, Stage II shows flexible flatfoot deformity, Stage III presents rigid deformity with subtalar arthritis, and Stage IV adds ankle valgus tilt. MRI is essential for evaluating tendon integrity, staging the disease, and assessing associated spring ligament damage. Our AI consortium analyzes tendon morphology, peritendinous changes, and hindfoot alignment across multiple sequences.
Axial PD-FS at the medial malleolus level is the primary sequence. PTTD grade I shows peritendinous fluid and tendon sheath distension with intact fibres and a calibre up to twice the flexor digitorum longus (FDL). Grade II demonstrates longitudinal intrasubstance splits, focal tendon thinning, or heterogeneous T2 signal with elongation and progressive flatfoot on weight-bearing radiographs. Grade III shows complete rupture with a fluid-filled gap. Coronal STIR images assess spring ligament integrity — a co-existing spring ligament tear (superomedial calcaneonavicular bundle) accelerates deformity progression.
AI models quantify PTT cross-sectional area, longitudinal tear length, and spring ligament signal on MRI, mapping pathology to the Johnson-Strom classification used surgically. Stage I (tenosynovitis, intact tendon) is treated with debridement; Stage II (elongated, attenuated tendon with flexible deformity) requires FDL transfer and calcaneal osteotomy; Stage III (rigid flatfoot with subtalar arthritis) needs triple arthrodesis. AI measurement of tendon-to-FDL diameter ratio and spring ligament tear extent reduces inter-reader variability and informs which reconstructive procedure achieves optimal arch restoration.
Yes. The medial ankle contains the Tom, Dick, and Harry tendons — tibialis posterior, FDL, and flexor hallucis longus (FHL) — in the tarsal tunnel. Axial sequences clearly separate each tendon by position: PTT is the most anterior and largest, directly behind the medial malleolus, inserting on the navicular tuberosity. FHL lies posteriorly between the medial and lateral talar processes — isolated FHL tenosynovitis produces posterior ankle pain and hallux triggering. AI-assisted MRI review maps signal and calibre abnormality to the specific tendon, guiding targeted injection or surgical intervention.
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