A bursa between the distal tibialis posterior tendon and the medial malleolus or spring ligament as the tendon curves beneath the medial malleolus, supplementing the tendon sheath at the point of maximal friction during foot pronation.
Tibialis posterior distal bursitis contributes to the medial ankle pain of early posterior tibial tendon dysfunction (PTTD), where bursal swelling accompanies tenosynovitis at the medial malleolus level. Ultrasound demonstrates peritendinous fluid at the retromalleolar groove. It must be distinguished from the more proximal tibialis posterior origin bursa. Injection at the distal tendon level addresses this bursa and the associated tenosynovitis simultaneously.
Bursal swelling at the retromalleolar groove producing medial ankle pain with walking, an early feature of PTTD, managed with orthotics addressing hindfoot valgus and guided injection.
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