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.