59F with suspected PTT tear

This is an anatomy question.  Is the segment indicated by the white arrow an accessory slip of the PTT or the plantar navicular-medial cuniform capsule?  The red arrow indicates the main insertion onto the medial pole navicular. References mention accessory slips inserting onto the cuneiforms and 2nd-4th MT bases.  I'm not clear if that includes the base of the medial cuneiform.  Do you know?

Symphony of Ankle and Foot Avulsions 30M

Red arrows point to the avulsion of the posterior margin of the medial malleolus by the flexor retinaculum.
Yellow arrow indicates partial deep deltoid ligament tear (there are also complete ATFL and CFL tears, not shown).
Blue arrow shows talar avulsion of talonavicular ligament.
White arrow shows avulsion of the anterior calcaneal process by the bifurcate ligament.
Lat XR from orthopedist shows the sizeable posterior med malleolar and small dorsal talar ridge avulsions.

 

48M 8 months post op FHL transfer for Achilles Rupture

Sag PDFS

Sag T1 arrows shows old healed osteotomy

Cor T2FS

Ax PDFS

The referrer requested assessement of Achilles (specified "posterior tendon") healing, now 8 months after FHL transfer for Achilles rupture.

In the T1-weighted image you can see a healed calcaneal osteotomy, and there is suture artifact around the distal achilles, related to a more remote Haglund's procedure which pre-dated the complete tendon rupture in the hypovascular zone.

Now 8 months out, there is some intrasubstance bright T2 signal at the anterior insertion of the FHL onto the posterosuperior calcaneus, surrounding a bioabsorbable screw, possibly reaction to the screw degradation.

I am both surprised that the referrer wants to evaluate healing of the native achilles, and that there is persistent bright T2 signal in a >3cm achilles defect so long after the initial injury.

Isn't the FHL now replacing rather than augmenting the achilles in this instance?

Why is it important to assess healing of the achilles defect?