Translating MRIese

Too often MRIs don’t tell the whole story.  They don’t lie, but they don’t tell the whole story.  They simply look at a certain joint or joints close together staying still.  MRIs don’t tell you anything about how these joint move or how they are impacted by other joints when the whole body is moving.

Below is the summary of an MRI of a gentleman that has been struggling through some garbage PT elsewhere.  I train his son, who is what I call a student of the game.  This is a non-training or rehab professional, but they scour and read and train themselves quite well.  I expect these folks to typically be more skilled than most physical therapists.

Impression: Extensive abnormality associated with the posterior tibial tendon.  Findings most consistent with hypertrophic tear, primarily involving the navicular insertional components of the posterior tibial tendon, with associated advanced diffuse synovitis (most likely chronic, fibrosing synovitis with superimposed acute component).

Probable partial longitudinal tear at the musculotendinous junction of the peroneus longus tendon, and mild tenosynovitis.

Chronic achilles tendonitis and mild paratenonitis.

Translation for my patient/client to give to his Dad (just from above information; never seen the guy)

1.  The posterior tibial tendon is f’d.  Put your index and middle fingers on the backside of the medial malleolus (bump on outside of foot).  Now pull your foot inward.  That is the posterior tibial tendon.  It attaches to the navicular bone, which is the roof of the arch of the foot, and goes up to behind the calf.  It appears there is strain throughout the tendon.  Get him into an orthotic quickly to limit pain in this regard.
I would go gua sha aggressively at this tendon, but it may require surgery if that does not work.

2.  Peroneus longus is on the other side of the foot.  It starts @ the fibular head below the knee and runs to bottom of the foot, sometimes to the navicular.  Put your fingers on the lateral malleolus now and push your foot out.  This is the peroneal sheath which has the longus along with brevis and tertious.
Gua Sha again, but it appears the stability of the navicular is in question.  Bolting it up may be something to be discussed, but I think that should be avoided at all costs.
3.  Achilles tendonosis (not tendonitis) is to be expected as the foot tries to remain equine from a forward weight shift and minimizing closing the joint space.
Basically I would expect his whole foot to be locked up and some advanced tendonosis everywhere.  I would recommend soft tissue to stimulate some healing action in the whole foot and then try to recoup the hips and core with ASLR and Shoulder Mobility.
This is a classic simple isn’t always easy case.  Depends how bad things have gotten and how stable the navicular is.
  • June 20, 2010

Leave a Reply 6 comments

Trish West-Low Reply

Charlie,
You are a genius. These posts are aweseom even for someone who works with kids who are not athletes. What is ASLR?

Charlie Reply

Trish – Thank you. ASLR = Active Straight Leg Raise. It is one of the 7 screens in the Functional Movement Screen that screens for hip mobility and unloaded supine core stability.
The screen itself is an active SLR measuring how far the moving leg goes without the bottom leg flexing at the knee or ER at the hip. It scores a zero if there is pain, 1 if the moving leg’s lateral malleolus is beneath inferior to the down leg knee, 2 if it is between the knee and mid-thigh, and 3 if it is above the thigh.
ASLR is a function of downside hip extension, upside hamstring length, hip flexion dynamic stability, pelvis separation for stride, and rotary core stability. It comes first along with shoulder mobility as baby plays with feet first, and rotation in supine is perhaps the most crucial or at least the 1st NDT landmark.

Nate Brookreson Reply

Hey Charlie, was wondering if at some point you wouldn’t mind doing a blog with your thoughts / interpretations of all of the FMS assessments. I think it would be tremendous.

Charlie Reply

Nate, what do you mean by interpretations?

Nate Brookreson Reply

Perhaps “interpretations” is the wrong word choice, but more of the explanations behind the relationships between the FMS assessments and various developmental stages, and how people generally “loose” their ability to perform the pattern. Maybe this is still too vague…

Charlie Reply

It may be too vague still, yes, but I think I can show something that may be of interest. I will put it in the queue.

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