Notice the mildly to moderately hypoechoic area with the deep digital flexor tendon and corresponding irregular fiber pattern. There was also moderate anechoic effusion and moderate synovial proliferation within the tarsal sheath. The final diagnosis was deep digital flexor tendonitis and associated tarsal sheath tenosynovitis caused by bony irregularity along the sustentaculum tali.

Additional imaging included tarsal radiographs which revealed osseous proliferation and sclerosis along the plantaromedial aspect of the sustentaculum tali. Tenoscopy of the tarsal sheath was performed followed by intrathecal injection of steroids and Atropine at a later visit.