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Note heterotopic ossification embedded in the talonavicular ligament (blue arrow). You can see this with previous TNL sprain or PTTD due to stress as the arch collapses. There is pes planovalgus in this case. Yellow arrow indicates sinus tarsi inflammation, which commonly accompanies PTTD.
Red arrow indicated PT tendinosis and partial tear.
The superomedial spring ligament often degenerates and tears in concert with the PTT. The Superomedial spring (CNL) is attenuated and partially torn (arrowhead). The white arrow indicates reactive edema along the posterior med malleolus, deep to the PTT at the ankle, with superficial pressure erosion and spurring at the flexor retinaculum insertion, all of which indicate chronicity.
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