Tendon of tibialis posterior - Lower extremity - Muscles of lower limb - e-Anatomy
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Tendon of tibialis posterior

Tendo musculi tibialis posterioris

  • Synonym: Posterior tibial tendon
  • Acronym: PTT
  • Related terms: Tibialis posterior : Tendon; Tibialis posterior (Tendon)

Definition

Antoine Micheau

The tendon of the tibialis posterior muscle exhibits significant anatomical complexity and variability. The primary insertion of the TPM tendon is on the navicular bone and the medial cuneiform bone. However, it also has multiple accessory insertions, which can include the intermediate and lateral cuneiform bones, the cuboid bone, and the bases of the second, third, and fourth metatarsal bones.[1-2]

A study by Olewnik et al. classified the tendon insertions into four types based on anatomical dissections:

• Type I: Single band insertion to the navicular and medial cuneiform bones (16.25%).

• Type II: Double distal attachment (22.5%).

• Type III: Triple distal attachment, the most common type, with the main tendon inserting to the navicular and medial cuneiform bones, and two accessory bands inserting to various other bones (43.75%).

• Type IV: Quadruple distal attachment (17.5%).[1]

Additionally, the tendon wraps around the medial malleolus, where it changes direction and is subject to compressive and shear forces. This region is characterized by a fibrocartilaginous structure, which may be more susceptible to injury due to repetitive stress.[3-4]

References

1.A Proposal for a New Classification for the Tendon of Insertion of Tibialis Posterior.Olewnik Ł.Clinical Anatomy (New York, N.Y.). 2019;32(4):557-565. doi:10.1002/ca.23350.

2.Complex Distal Insertions of the Tibialis Posterior Tendon: Detailed Anatomic and MR Imaging Investigation in Cadavers.Pastore D, Dirim B, Wangwinyuvirat M, et al.Skeletal Radiology. 2008;37(9):849-55. doi:10.1007/s00256-008-0499-3.

3.Collagenous Fibril Texture of the Gliding Zone of the Human Tibialis Posterior Tendon.Petersen W, Hohmann G.Foot & Ankle International. 2001;22(2):126-32. doi:10.1177/107110070102200208.

4.Structure of the Human Tibialis Posterior Tendon.Petersen W, Hohmann G, Pufe T, et al.Archives of Orthopaedic and Trauma Surgery. 2004;124(4):237-42. doi:10.1007/s00402-003-0500-5.

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