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Ji X, Li H, Li H, Tong J, Hua Y. Safe Talar Tunnel Placement During Reconstruction of the Deep Layer of the Deltoid Ligament: A Comparison of 4 Different Anatomic Landmarks on the Lateral Malleolus. Orthop J Sports Med 2023; 11:23259671231211560. [PMID: 38035217 PMCID: PMC10687947 DOI: 10.1177/23259671231211560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 12/02/2023] Open
Abstract
Background Deltoid ligament reconstruction of the ankle can be considered when the ruptured ligament is insufficient for direct repair. Purpose To compare the safety of talar tunnels oriented toward 4 different anatomic landmarks on the lateral malleolus during reconstruction of the deep layer of the deltoid ligament (DDL). Study Design Descriptive laboratory study. Methods A total of 30 computed tomography scans of the ankle joint in healthy adults were collected to generate 3-dimensional models. Virtual talar tunnels with a diameter of 5 mm and with different lengths (20.0, 25.0, and 30.0 mm) were created from the talar insertion of the DDL and were oriented toward the talar neck as well as the most anterior, the most distal, and the most posterior points of the distal fibula. The minimal safe distance (MSD) of a drilling route was calculated for the tunnels, and the safe distance from the end of the tunnel to the bone surface was measured for each tunnel. The nonpaired Student t test was used to detect differences among the safe distances of the 4 different bone tunnels. Results For the 20.0-mm tunnels, the safe distance of the tunnel oriented toward the talar neck (5.90 ± 1.16 mm) did not meet the MSD (6.0 mm). For the 25.0-mm tunnels, the safe distances of the tunnels oriented toward the talar neck (4.53 ± 1.13 mm) and the anterior point of the fibula (5.91 ± 1.52 mm) did not meet the MSD (6.9 mm). Conclusion Tunnels that were 5 mm in diameter and 20.0 and 25.0 mm in length, oriented toward the most distal or most posterior point of the distal fibula, were safe for DDL reconstruction. Clinical Relevance Knowledge of safe talar tunnel placement is important, especially to avoid bone surface penetration during DDL reconstruction.
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Affiliation(s)
- Xiaoxi Ji
- Sports Medicine Center, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongyun Li
- Sports Medicine Center, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong Li
- Sports Medicine Center, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiahui Tong
- Sports Medicine Center, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yinghui Hua
- Sports Medicine Center, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
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Takabayashi T, Edama M, Inai T, Kubo M. Differences in the coordination and its variability among foot joints during running in neutral foot and flatfoot. Scand J Med Sci Sports 2023; 33:235-245. [PMID: 36349506 DOI: 10.1111/sms.14267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/08/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
Flatfoot is a well-known foot deformity, with a prevalence of 11.2%-29.0% among adults. Running injuries can occur in individuals with flatfoot; however, the underlying mechanism remains unknown. We investigated the coordination pattern and variability among foot joints while running by comparing participants with neutral foot and with flatfoot. Participants with neutral foot (n = 15) and flatfoot (n = 15) were asked to run at their preferred speed. Using the modified vector coding technique, the coupling angle between the foot joints, representing interjoint coordination, was calculated and categorized into four coordination patterns. The standard deviation of the coupling angle was computed to measure the coordination variability during the stance phase. There were no differences in the spatiotemporal parameters (speed, step length, and cadence) between the groups. In the sagittal rearfoot and sagittal midfoot coordination patterns, the flatfoot group showed a significantly greater proportion of anti-phase with proximal dominancy and a lower proportion of in-phase with proximal dominancy than the neutral foot group during early stance. Coordination variabilities between the sagittal rearfoot and sagittal midfoot (midstance), between the sagittal midfoot and sagittal forefoot (early stance), and between the frontal rearfoot and sagittal midfoot (midstance) were greater in the flatfoot group than in the neutral foot group. This may explain why those with flatfoot are likely to experience running injuries.
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Affiliation(s)
- Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Takuma Inai
- National Institute of Advanced Industrial Science and Technology, Exercise motivation and Physical function Augmentation Research Team, National Institute of Advanced Industrial Science and Technology, University of Tokyo, Chiba, Japan
| | - Masayoshi Kubo
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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3
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Histologic grading correlates with inflammatory biomarkers in tibialis posterior tendon dysfunction. Foot Ankle Surg 2022; 28:1266-1271. [PMID: 35667952 DOI: 10.1016/j.fas.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/17/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND It has been theorized that tibialis posterior tendon dysfunction (TPTD) is a degenerative process unrelated to inflammation. The purpose of this study was to determine if inflammatory cytokines, matrix metalloproteases (MMPs), and glutamate were elevated in diseased tibialis posterior tendons (TPTs). METHODS Matched diseased TPT, TPT insertion, and flexor digitorum longus (FDL) samples were collected from 21 patients. The samples were individually incubated in media, which was analyzed for inflammatory cytokines, MMPs, and glutamate. Histology and statistical analyses were performed. RESULTS Diseased TPT and TPT insertion were significantly elevated compared to transferred FDL in eight inflammatory markers (p < 0.005). Only the diseased TPT was significantly elevated compared to the transferred FDL tendons for glutamate (p < 0.01). Histologic grading correlated with inflammatory cytokine levels. CONCLUSION Diseased TPT and TPT insertion demonstrated significantly elevated levels of inflammatory markers compared to the transferred tendons used as controls, suggesting a role for inflammation in the disease process. The amount of inflammation correlated with increased tendon degradation. LEVEL OF EVIDENCE Level III.
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Milani C, Vyas K, Malik G. Evidence-Based Diagnosis and Treatments of Posterior Tibialis Tendinopathy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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5
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Zannoni S, Bonifacini C, Albano D, Messina C, Sconfienza LM. Posterior Tibial Tendon Dislocation: A Case Report. J Foot Ankle Surg 2022; 61:417-420. [PMID: 34670676 DOI: 10.1053/j.jfas.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/27/2020] [Accepted: 09/06/2021] [Indexed: 02/03/2023]
Abstract
Isolated posterior tibial tendon dislocation is a rare condition. Diagnosis can be challenging, especially in the acute clinical setting. Predisposing factors include shallow posterior tibial tendon groove and tear of the flexor retinaculum. We report the case of traumatic subluxation of the posterior tibial tendon, illustrating imaging findings and surgical technique. Posterior tibial tendon dislocation was detected using dynamic ultrasound, while magnetic resonance was essential for a comprehensive evaluation that included underlying predisposing anatomic abnormalities and associated pathologic conditions. Conservative treatment is often unsuccessful thus surgical approach was needed. Under ampliscopic guidance, a bone tunnel was created behind the retromalleolar groove. The posterior tibial tendon was located into the new groove and the retinaculum was re-attached and tightened by anchors and absorbable sutures at the anterior margin of the sulcus. At 12-month follow-up, the patient did not complain any residual pain and he was able to perform normal daily activities without any limitations and with no further tendon dislocations.
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Affiliation(s)
- Stefania Zannoni
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy
| | - Carlo Bonifacini
- IRCCS Istituto Ortopedico Galeazzi, Foot and Ankle Surgery, Milano, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy; Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy.
| | | | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
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6
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Rips L, Luik M, Koovit T, Rahu M. Lower leg muscle recovery takes at least 12 months for functional tests to recover after late reconstruction of the tibialis posterior tendon retinaculum. BMJ Case Rep 2022; 15:e247273. [PMID: 35039374 PMCID: PMC8768871 DOI: 10.1136/bcr-2021-247273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2021] [Indexed: 11/04/2022] Open
Abstract
Traumatic dislocation of the tibialis posterior tendon is an extremely rare injury with few reported cases. It is a complicated injury with high risk of misdiagnosis and mistreatment. MRI is the best tool for diagnosis. Surgical treatment has been reported to have a better outcome than conservative treatment. In the present case, a 23-year-old female athlete sustained a sports-related traumatic tibialis posterior tendon dislocation with retinaculum rupture. The patient underwent late reconstruction of the ruptured retinaculum followed by a personalised rehabilitation programme. Full recovery was achieved after 19 months according to European Foot and Ankle Society Score and Foot and Ankle Outcome Score. Lower leg muscle strength continued to improve until 6 months after surgery in isokinetic strength and physical performance tests.
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Affiliation(s)
- Leho Rips
- Sports Medicine and Rehabilitation Clinic Sports Traumatology Center, Tartu University Hospital, Tartu, Tartumaa, Estonia
| | - Mihkel Luik
- Sports Medicine and Rehabilitation Clinic Sports Traumatology Center, Tartu University Hospital, Tartu, Tartumaa, Estonia
| | - Tauno Koovit
- Sports Medicine and Rehabilitation Clinic Sports Traumatology Center, Tartu University Hospital, Tartu, Tartumaa, Estonia
| | - Madis Rahu
- Sports Medicine and Rehabilitation Clinic Sports Traumatology Center, Tartu University Hospital, Tartu, Tartumaa, Estonia
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7
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Gkoudina A, Graikos G, Chatziargiriou M, Saloupis P. Posterior Tibialis Tendon Dislocation: Case Report and Review of Literature. Cureus 2021; 13:e19301. [PMID: 34900478 PMCID: PMC8649983 DOI: 10.7759/cureus.19301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 11/26/2022] Open
Abstract
Posterior tibialis tendon (PTT) dislocation is an extremely rare yet significant finding in cases with recalcitrant pain over the medial malleolus, usually as a consequence of trauma. The diagnosis is frequently delayed, as the patient’s initial clinical presentation generally resembles benign musculoskeletal pathology of the ankle joint. Herein, we report the case of a female patient diagnosed with PTT dislocation after four weeks of conservative management for an ankle sprain. Surgical intervention, including retromalleolar groove-deepening and repair of flexor retinaculum with intraosseous suture anchors, proved to be successful after a mean follow-up of 12 months. A thorough literature review was conducted regarding the aforementioned injury, concluding that PTT dislocation-in spite of its rarity-should be included in the differential diagnosis of patients with importunate pain on medial malleolus after an ankle injury.
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Affiliation(s)
| | - Georgios Graikos
- Orthopedics and Traumatology, George Papanikolaou General Hospital of Thessaloniki, Thessaloniki, GRC
| | | | - Panagiotis Saloupis
- Orthopedics and Traumatology, Ippokrateio Hospital of Thessaloniki, Thessaloniki, GRC
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8
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Talebi S, Sheibani S, Ghaffari S, Ghadiri A. Posterior tibialis tendon rupture concomitant with a closed medial malleolar fracture: A case report and literature review. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2021. [DOI: 10.1177/22104917211025812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Traumatic rupture of the posterior tibialis tendon is an extremely infrequent condition, which mostly occurred due to a traumatic mechanism of pronation and external rotation, less commonly in direct trauma on the medial side of the ankle. This lesion is overlooked preoperatively most of the time because of the limitation of physical examination owing to acute pain and swelling secondary to a medial malleolar fracture. Early diagnosis and treatment of this injury are very important to prevent the complications like acquired flatfoot deformity. Few cases have been described in the literature for the posterior tibialis tendon rupture associated with a closed ankle fracture. Here we report an acute rupture of the posterior tibialis tendon associated with a closed medial malleolar fracture after a high-energy trauma in a healthy 33-year-old man. We fixed the medial malleolar fracture with two screws and repaired the tendon with a direct end-to-end suture. We hope that our study can be helpful for other colleagues to consider this lesion in similar circumstances.
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Affiliation(s)
- Shahin Talebi
- Orthopedic Research Center, Mazandaran University of Medical Science, Iran
| | - Shirin Sheibani
- School of Medicine, Mazandaran University of Medical Science, Iran
| | - Salman Ghaffari
- Orthopedic Research Center, Mazandaran University of Medical Science, Iran
| | - Abolfazl Ghadiri
- Orthopedic Research Center, Mazandaran University of Medical Science, Iran
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9
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Phillips WT, Gorzell BC, Martinez RA, Salman UA, Cooper AW, Stocker DJ, Adams CC. Fewer-Angle SPECT/CT Blood Pool Imaging for Infection and Inflammation. J Nucl Med Technol 2020; 49:39-43. [PMID: 33361187 DOI: 10.2967/jnmt.120.256933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/22/2020] [Indexed: 11/16/2022] Open
Abstract
A new protocol for rapid SPECT/CT blood pool imaging consisting of fewer image-angle acquisitions (fewer-angle SPECT/CT, or FASpecT/CT) was evaluated for localization of focal sites of soft-tissue inflammation, infection, and osteomyelitis. Methods: Immediately after dynamic flow and standard planar blood pool imaging with 99mTc-methylene diphosphonate, FASpecT/CT was performed with a dual-head γ-camera consisting of 6 steps over 360°, 12 total images with 30° of separation between angles, and 30 s per image, requiring a total imaging time of approximately 3 min. Images were reconstructed using iterative ordered-subset expectation maximization. Before use in a patient-care setting, various FASpecT/CT acquisition protocols were modeled using a phantom to determine the minimum number of stops and the stop duration required to produce a reliable image. Results: FASpecT/CT images provided excellent 3-dimensional localization of spine osteomyelitis, soft-tissue infection of the foot, and tendonitis of the hand and foot using a 3-min image acquisition time. The FASpecT/CT acquisition protocol required 1.3-3.5 min, including camera movement time. This was a reduction of 72%-90% from the time required for the standard 60-angle, 20-s SPECT/CT acquisition. Conclusion: The ability of FASpecT/CT blood pool images to help localize focal sites of hyperemia and inflammation can increase exam sensitivity and specificity. Additionally, using a FASpecT/CT protocol decreases imaging time by up to 90%.
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Affiliation(s)
- William T Phillips
- Department of Radiology, University of Texas Health Science Center, San Antonio, Texas.,Department of Radiology, University Hospital, San Antonio, Texas; and
| | - Brandon C Gorzell
- Department of Radiology, University of Texas Health Science Center, San Antonio, Texas
| | - Robert A Martinez
- Department of Radiology, University of Texas Health Science Center, San Antonio, Texas
| | - Umber A Salman
- Department of Radiology, University Hospital, San Antonio, Texas; and
| | - Albert W Cooper
- Department of Radiology, University of Texas Health Science Center, San Antonio, Texas
| | - Derek J Stocker
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Chad C Adams
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Maryland
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10
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Ankle medial flexor retinaculum avulsion fracture. Radiol Case Rep 2019; 14:1144-1147. [PMID: 31360277 PMCID: PMC6639679 DOI: 10.1016/j.radcr.2019.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 06/19/2019] [Accepted: 06/30/2019] [Indexed: 11/20/2022] Open
Abstract
Medial flexor retinaculum injuries are not uncommon, but medial flexor retinaculum periosteal avulsion injuries are rare. This patient sustained a medial flexor retinaculum tear readily characterized at computed tomography by an associated proximal retinacular avulsion fracture from the posteromedial tibia. Medial flexor retinaculum injury is often also associated with superficial deltoid pathology and/or medial malleolar fracture. An additional significant complication of medial flexor retinaculum tear is anterior dislocation of the tibialis posterior tendon, which heralds a tibialis posterior fibro-osseous tunnel injury.
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11
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El Rayes J, Bou Sader R, Moutran M, Rassi S, Boueri W. Biologically Enhanced Hamstring Tendon Transfer for Treatment of Acute Rupture of Posterior Tibialis Tendon in an Athlete: Case Report. J Foot Ankle Surg 2019; 58:647-652. [PMID: 30448181 DOI: 10.1053/j.jfas.2018.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Indexed: 02/03/2023]
Abstract
We report the case of a 32-year-old basketball player who presented with an acute flatfoot deformity after performing a unipodal power jump. Rupture of the posterior tibial tendon within the foot was diagnosed and then treated by hamstring tendon transfer combined with application of autologous biologic preparations. The functional outcome at 18 months was good. To our knowledge, this is the first reported case of posterior tibial tendon rupture treated by hamstring tendon transfer.
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Affiliation(s)
- Johnny El Rayes
- Surgeon, Department of Orthopedic Surgery, Bellevue University Medical Center, Mansourieh, Lebanon.
| | - Roula Bou Sader
- Radiologist, Department of Radiology, Bellevue University Medical Center, Mansourieh, Lebanon
| | - Michel Moutran
- Surgeon, Department of Plastic Surgery, Bellevue University Medical Center, Mansourieh, Lebanon
| | - Sahar Rassi
- Pathologist, Institut National de Parthologie INP, Hadeth, Lebanon
| | - Wissam Boueri
- Surgeon, Department of Orthopedic Surgery, Sports Medicine, Bellevue University Medical Center, Mansourieh, Lebanon
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12
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Sakakibara Y, Kura H, Teramoto A, Yamashita T. Early surgical management of traumatic dislocation of the tibialis posterior tendon: a case report and review of the literature. J Med Case Rep 2018; 12:348. [PMID: 30466481 PMCID: PMC6251192 DOI: 10.1186/s13256-018-1872-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 10/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic dislocation of the tibialis posterior tendon at the ankle is a rare injury. Some of these cases are misdiagnosed as ankle sprains and are not treated properly. In addition, because the conservative treatment is not as effective as the surgical treatment, it is essential that patients be diagnosed early so that proper surgical treatment can be performed. We report the early surgical management of traumatic dislocation of the tibialis posterior tendon. CASE PRESENTATION A 44-year-old Japanese man, who was a karate coach, was injured while acting as an umpire in a karate competition. On the same day of his injury, he came to our hospital. He complained of swelling and pain in the medial malleolus. Anterior dislocation of the tibialis posterior tendon was detected upon palpation. Magnetic resonance imaging showed the presence of anterior dislocation of the tibialis posterior tendon with retinaculum injury. Four days after the injury, we performed the Das De procedure as the surgical treatment. Three months after the surgery, the patient was able to participate in karate again. CONCLUSIONS Dislocation of the tibialis posterior tendon is likely to be misdiagnosed, thus delaying the start of proper treatment. It is essential to diagnose the patient accurately by carefully assessing the physical symptoms manifested. Moreover, magnetic resonance imaging can also be used for better diagnosis, thereby leading to an early and proper surgical treatment.
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Affiliation(s)
- Yuzuru Sakakibara
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
| | - Hideji Kura
- Department of Orthopaedic Surgery, Hitsujigaoka Hospital, 004-0021, 3-1-10, Aoba Town, Atsubetu ward, Sapporo, Hokkaido Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
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13
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Wong DWC, Wang Y, Leung AKL, Yang M, Zhang M. Finite element simulation on posterior tibial tendinopathy: Load transfer alteration and implications to the onset of pes planus. Clin Biomech (Bristol, Avon) 2018; 51:10-16. [PMID: 29144991 DOI: 10.1016/j.clinbiomech.2017.11.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Posterior tibial tendinopathy is a challenging foot condition resulting in pes planus, which is difficult to diagnose in the early stage. Prior to the deformity, abnormal internal load transfer and soft tissue attenuation are anticipated. The objective of this study was to investigate the internal load transfer and strain of the ligaments with posterior tibial tendinopathy, and the implications to pes planus and other deformities. METHODS A three-dimensional finite element model of the foot and ankle was reconstructed from magnetic resonance images of a 28-year-old normal female. Thirty bones, plantar fascia, ligaments and tendons were reconstructed. With the gait analysis data of the model subject, walking stance was simulated. The onset of posterior tibial tendinopathy was resembled by unloading the tibialis posterior and compared to the normal condition. FINDINGS The load transfer of the joints at the proximal medial column was weaken by posterior tibial tendinopathy, which was compromised by the increase along the lateral column and the intercuneiforms during late stance. Besides, the plantar tarsometatarsal and cuboideonavicular ligaments were consistently over-stretched during stance. Particularly, the maximum tensile strain of the plantar tarsometatarsal ligament was about 3-fold higher than normal at initial push-off. INTERPRETATION Posterior tibial tendinopathy altered load transfer of the medial column and unbalanced the load between the proximal and distal side of the medial longitudinal arch. Posterior tibial tendinopathy also stretched the midfoot plantar ligaments that jeopardized midfoot stability, and attenuated the transverse arch. All these factors potentially contributed to the progress of pes planus and other foot deformities.
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Affiliation(s)
- Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Yan Wang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Aaron Kam-Lun Leung
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Ming Yang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; Department of Pediatric Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Ming Zhang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.
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14
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Federer AE, Steele JR, Dekker TJ, Liles JL, Adams SB. Tendonitis and Tendinopathy: What Are They and How Do They Evolve? Foot Ankle Clin 2017; 22:665-676. [PMID: 29078821 DOI: 10.1016/j.fcl.2017.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The development of tendinitis and tendinopathy is often multifactorial and the result of both intrinsic and extrinsic factors. Intrinsic factors include anatomic factors, age-related factors, and systemic factors, whereas extrinsic factors include mechanical overload and improper form and equipment. Although tendinitis and tendinopathy are often incorrectly used interchangeably, they are in 2 distinct pathologies. Due to their chronicity and high prevalence in tendons about the ankle, including the Achilles tendon, the posterior tibialis tendon, and the peroneal tendons, tendinitis and tendinopathies cause significant morbidity and are important pathologies for physicians to recognize.
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Affiliation(s)
- Andrew E Federer
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA
| | - John R Steele
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA
| | - Travis J Dekker
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA
| | - Jordan L Liles
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA
| | - Samuel B Adams
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA.
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15
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Waldron JE, Bernhardson AS, Fellars TA. Unilateral Dislocation of the Posterior Tibialis Tendon (PTT) and Flexor Digitorum Longus Tendon With Contralateral PTT Subluxation in a Patient With Congenitally Shallow Flexor Groove. Foot Ankle Spec 2017; 10:480-483. [PMID: 28920487 DOI: 10.1177/1938640017699062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Flexor tendon dislocation from the flexor tendon groove posterior of the medial malleolus has been previously described, and may be difficult to diagnose initially, but is amendable to surgical treatment with good outcomes. We present a unique case of unilateral dislocation of the posterior tibialis and flexor digitorum longus tendons with contralateral flexor digitorum longus subluxation that was treated surgically with a good outcome. CASE PRESENTATION A 37-year-old active duty male sustained a dislocation and subluxation of the flexor tendons bilaterally after a forced dorsiflexion injury. Bilateral ankle magnetic resonance imaging revealed the injuries that this patient sustained and aided in surgical planning. Surgical Treatment. Bilateral flexor tendon groove deepening with periosteal flap elevation and retinacular repair. DISCUSSION/CONCLUSION This injury has not been previously described in the literature after a forced dorsiflexion mechanism. Advanced imaging is helpful as this injury may be initially misdiagnosed. This case shows that delayed bilateral reconstruction of the flexor tendon grooves and retinacula are reliable methods for pain relief to allow a patient to return to a physically demanding level of function. LEVELS OF EVIDENCE Level V.
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Affiliation(s)
- Jacob E Waldron
- Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, California
| | - Andrew S Bernhardson
- Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, California
| | - Todd A Fellars
- Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, California
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Fratani J, Ponssa ML, Abdala V. Tendinous framework of anurans reveals an all-purpose morphology. ZOOLOGY 2017; 126:172-184. [PMID: 29310934 DOI: 10.1016/j.zool.2017.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 01/14/2023]
Abstract
Tendons are directly associated with movement, amplifying power and reducing muscular work. Taking into account habitat and locomotor challenges faced by anurans, we identify the more conspicuous superficial tendons of a neotropical anuran group and investigate their relation to the former factors. We show that tendons can be visualized as an anatomical framework connected through muscles and/or fascia, and describe the most superficial tendinous layer of the postcranium of Leptodactylus latinasus. To analyze the relation between tendon morphology and ecological characters, we test the relative length ratio of 10 tendon-muscle (t-m) elements in 45 leptodactylid species while taking phylogeny into account. We identify the evolutionary model that best explains our variables. Additionally, we optimize t-m ratio values, and the shape of the longissimus dorsi insertion onto a selected phylogeny of the species. Our data show the existence of an all-purpose morphology that seems to have evolved independently of ecology and functional requirements. This is indicated by no significant relation between morphometric data of the analyzed tendons and habitat use or locomotion, a strong phylogenetic component to most of the analyzed variables, and a generalized pattern of intermediate values for ancestral states. Ornstein-Uhlenbeck is the model that best explains most t-m variables, indicating that stabilizing selection or selective optima might be driving shifts in tendon length within Leptodactylidae. Herein, we show the substantial influence that phylogeny has on tendon morphology, demonstrating that a generalized and stable morphological configuration of tendons is adequate to enable versatile locomotor modes and habitat use. This is an attempt to present the tendinous system as a framework to body support in vertebrates, and can be considered a starting point for further ecomorphological research of this anatomical system in anurans.
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Affiliation(s)
- Jéssica Fratani
- Unidad Ejecutora Lillo (CONICET-Fundación Miguel Lillo), Tucumán, Argentina; Departamento de Vertebrados, Museu Nacional, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - María Laura Ponssa
- Unidad Ejecutora Lillo (CONICET-Fundación Miguel Lillo), Tucumán, Argentina.
| | - Virginia Abdala
- Instituto de Biodiversidad Neotropical UNT-CONICET, Universidad Nacional de Tucumán, Tucumán, Argentina.
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Ruffilli A, Traina F, Giannini S, Buda R, Perna F, Faldini C. Surgical treatment of stage II posterior tibialis tendon dysfunction: ten-year clinical and radiographic results. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:139-145. [DOI: 10.1007/s00590-017-2011-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/27/2017] [Indexed: 11/24/2022]
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Ikuta Y, Adachi N, Nakasa T, Ochi M. Postoperative Repeat Dislocation of the Posterior Tibial Tendon: A Case Report. J Foot Ankle Surg 2017; 56:687-691. [PMID: 28476400 DOI: 10.1053/j.jfas.2017.01.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Indexed: 02/03/2023]
Abstract
Dislocation of the posterior tibial tendon is an uncommon condition. Although surgery is usually performed in most cases of posterior tibial tendon dislocation, postoperative repeat dislocation of the posterior tibial tendon has not been reported in the published data. We report the case of a 27-year-old male patient who experienced repeat dislocation of the posterior tibial tendon after a gymnastic landing, 44 months after initial retinaculum repair. For revision surgery, we reconstructed the flexor retinaculum in conjunction with deepening of the retromalleolar groove, because the groove was hypoplastic. He returned to competitive gymnastics and had not experienced subluxation or dislocation of the posterior tibial tendon at the 1-year follow-up examination.
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Affiliation(s)
- Yasunari Ikuta
- Orthopedist, Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
| | - Nobuo Adachi
- Professor, Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Assistant Professor, Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Mitsuo Ochi
- President, Hiroshima University, Hiroshima, Japan
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Accessory Navicular is Associated With Wider and More Prominent Navicular Bone in Pediatric Patients by Radiographic Measurement. J Pediatr Orthop 2017; 36:521-5. [PMID: 25887831 DOI: 10.1097/bpo.0000000000000489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Accessory navicular (AN) is a common anatomic variant that is known to cause medial foot pain. Surgery may be required for excision if conservative measures fail. Often, the medial border of the navicular is excised in addition to the AN during surgery. The purpose of this radiographic study is to determine if the presence of an AN is associated with a wider or more prominent navicular in pediatric patients compared with normal controls. METHODS This study included pediatric patients who received an initial plain anteroposterior foot radiograph between January 1, 2004 and December 31, 2012 and were between the ages of 10 and 20 years. Feet with an AN were compared with those without, while controlling for age. Male and female patients were analyzed independently. Feet with fractures, deformities, or previous surgeries were excluded. Radiographic measurements included the navicular width and the protrusion of the navicular bone medially. RESULTS A total of 592 feet were included. An AN was identified in 73 feet. Male patients were analyzed separately from females. Cases with 1 AN bone had similar-sized native navicular bones in the contralateral normal foot compared with controls with 2 normal feet (P>0.05). The presence of an AN was associated with a larger navicular width (male: P=0.02, female: P=0.02) and a larger medial protrusion percent (male: P<0.01, female: P<0.01). Age was controlled for. CONCLUSION On radiographic examination, feet with an AN had wider native navicular bones that protruded more medially than feet without an AN. LEVEL OF EVIDENCE Level IV-diagnostic.
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Durrant B, Chockalingam N, Morriss-Roberts C. Assessment and Diagnosis of Posterior Tibial Tendon Dysfunction: Do We Share the Same Opinions and Beliefs? J Am Podiatr Med Assoc 2017; 106:27-36. [PMID: 26895358 DOI: 10.7547/14-122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Posterior tibial tendon dysfunction is a disabling pathologic flatfoot disorder. Evidence supports the notion that this condition is poorly diagnosed by health-care professionals. In addition, opinion is divided as to the most appropriate assessment and diagnostic techniques used to reflect the progression or stage of the condition. Hence, this study intended to explore the views and opinions of health-care professionals who may be involved in its assessment and diagnosis. METHODS A two-phase sequential mixed methods design was used that combined a questionnaire survey and a focus group interview. RESULTS The questionnaire data were analyzed using the Kendall levels of concordance and the Cohen kappa statistic, and the focus group data were analyzed using thematic analysis, which led to three main themes: resource implications, scope of practice, and awareness of the condition. CONCLUSIONS This study highlights what may have been suspected previously but that has never been investigated in a structured manner. One approach to the assessment and diagnosis of posterior tibial tendon dysfunction is not necessarily the best, and depending on the clinical teams, different guidance may be required to ensure that patients are receiving the most appropriate and best care.
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Affiliation(s)
- Beverley Durrant
- Department of Podiatry, University of Brighton, Eastbourne, England
- Faculty of Health, Staffordshire University, Stoke-on-Trent, England
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Abstract
BACKGROUND Posterior tibial tendinopathy (PTT) is the most common cause of acquired (progressive) flatfoot deformity in adults. To date, PTT research has mainly focused on management rather than on causal mechanisms. The etiology of PTT is likely to be multifactorial because both intrinsic and extrinsic risk factors have been reported. We sought to critically evaluate reported etiologic factors for PTT and consider the concept of genetic risk factors. METHODS A detailed review of the literature published after 1936 was undertaken using English-language medical databases. RESULTS No clear consensus exists as to the relative importance of the risk factors reported, and neither has any consideration been given to a possible genetic basis for PTT. CONCLUSIONS To date, studies have examined various intrinsic and extrinsic risk factors implicated in the etiology of PTT. The interaction of these factors with an individual's genetic background may provide valuable data and help offer a more complete risk profile for PTT. A properly constructed genetic association study to determine the genetic basis of PTT would provide a novel and alternative approach to understanding this condition.
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Affiliation(s)
- Paul Beeson
- Division of Podiatry, The University of Northampton, Park Campus, Boughton Green Road, Northampton, Northamptonshire, NN2 7AL, England. (E-mail: )
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Abstract
Abnormalities of the medial ligaments and posterior tibial tendon can occur because of acute injury or chronic instability or malalignment. Medial ankle injuries may occur because of pronation or supination-external rotation injuries. Deltoid ligament injuries have a significant impact on lateral ankle instability but can be overlooked in patients with lateral ligament injuries. Posterior tibial tendon dysfunction is usually associated with spring ligament or flexor retinaculum injury. Tarsal tunnel syndrome, accessory flexor muscles, and subtalar coalition should be considered as well as ligament and tendon tears in differential diagnosis of chronic medial ankle pain.
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Affiliation(s)
- Julia Crim
- Department of Radiology, University of Missouri, 3801 Kinsey Court, Columbia, MO 65203, USA.
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Mullens J, Whiteside W, Nilssen E, Kennedy C. Dislocated Posterior Tibial Tendon Treated With Plate Buttress Fixation in a Collegiate Gymnast: A Case Report and Review of the Literature. Foot Ankle Spec 2016; 9:361-6. [PMID: 26446101 DOI: 10.1177/1938640015609985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Dislocation of the posterior tibial tendon (PTT) is a rare pathological process that occurs most often as a result of acute trauma. The injury involves forced dorsiflexion and eversion of the foot against a contracted posterior tibialis. Diagnosis of the injury is often difficult secondary to the rarity of the injury and its similarity with other benign injuries of the medial ankle. Routine diagnostic imaging often does not reveal the injury, and advanced imaging with magnetic resonance imaging or ultrasound to confirm the diagnosis is often required. The injury can be a result of an abnormal retromalleolar groove or a tear of the flexor retinaculum. Because nonoperative treatment frequently results in poor outcomes with continuing pain and progressive flat foot, operative treatment with repair of the flexor retinaculum with correction of the retromalleolar groove is the most described intervention. We report an acute case of PTT dislocation in a collegiate gymnast during competition and offer our technique for surgical correction in the setting of a partially torn, attenuated flexor retinaculum with plate buttressing of the PTT into its native uncorrected groove. LEVELS OF EVIDENCE Therapeutic, Level IV: Case study.
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Affiliation(s)
- Jess Mullens
- Department of Orthopedic Surgery, University of South Alabama, Mobile, Alabama (JM)Andrews Research and Education Institute, Foot and Ankle Center, Gulf Breeze, Florida (WW, EN, CK)
| | - William Whiteside
- Department of Orthopedic Surgery, University of South Alabama, Mobile, Alabama (JM)Andrews Research and Education Institute, Foot and Ankle Center, Gulf Breeze, Florida (WW, EN, CK)
| | - Erik Nilssen
- Department of Orthopedic Surgery, University of South Alabama, Mobile, Alabama (JM)Andrews Research and Education Institute, Foot and Ankle Center, Gulf Breeze, Florida (WW, EN, CK)
| | - Chad Kennedy
- Department of Orthopedic Surgery, University of South Alabama, Mobile, Alabama (JM)Andrews Research and Education Institute, Foot and Ankle Center, Gulf Breeze, Florida (WW, EN, CK)
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Blasimann A, Eichelberger P, Brülhart Y, El-Masri I, Flückiger G, Frauchiger L, Huber M, Weber M, Krause FG, Baur H. Non-surgical treatment of pain associated with posterior tibial tendon dysfunction: study protocol for a randomised clinical trial. J Foot Ankle Res 2015; 8:37. [PMID: 26279682 PMCID: PMC4536665 DOI: 10.1186/s13047-015-0095-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 08/04/2015] [Indexed: 12/31/2022] Open
Abstract
Background Symptoms associated with pes planovalgus or flatfeet occur frequently, even though some people with a flatfoot deformity remain asymptomatic. Pes planovalgus is proposed to be associated with foot/ankle pain and poor function. Concurrently, the multifactorial weakness of the tibialis posterior muscle and its tendon can lead to a flattening of the longitudinal arch of the foot. Those affected can experience functional impairment and pain. Less severe cases at an early stage are eligible for non-surgical treatment and foot orthoses are considered to be the first line approach. Furthermore, strengthening of arch and ankle stabilising muscles are thought to contribute to active compensation of the deformity leading to stress relief of soft tissue structures. There is only limited evidence concerning the numerous therapy approaches, and so far, no data are available showing functional benefits that accompany these interventions. Methods After clinical diagnosis and clarification of inclusion criteria (e.g., age 40–70, current complaint of foot and ankle pain more than three months, posterior tibial tendon dysfunction stage I & II, longitudinal arch flattening verified by radiography), sixty participants with posterior tibial tendon dysfunction associated complaints will be included in the study and will be randomly assigned to one of three different intervention groups: (i) foot orthoses only (FOO), (ii) foot orthoses and eccentric exercise (FOE), or (iii) sham foot orthoses only (FOS). Participants in the FOO and FOE groups will be allocated individualised foot orthoses, the latter combined with eccentric exercise for ankle stabilisation and strengthening of the tibialis posterior muscle. Participants in the FOS group will be allocated sham foot orthoses only. During the intervention period of 12 weeks, all participants will be encouraged to follow an educational program for dosed foot load management (e.g., to stop activity if they experience increasing pain). Functional impairment will be evaluated pre- and post-intervention by the Foot Function Index. Further outcome measures include the Pain Disability Index, Visual Analogue Scale for pain, SF-12, kinematic data from 3D-movement analysis and neuromuscular activity during level and downstairs walking. Measuring outcomes pre- and post-intervention will allow the calculation of intervention effects by 3×3 Analysis of Variance (ANOVA) with repeated measures. Discussion The purpose of this randomised trial is to evaluate the therapeutic benefit of three different non-surgical treatment regimens in participants with posterior tibial tendon dysfunction and accompanying pes planovalgus. Furthermore, the analysis of changes in gait mechanics and neuromuscular control will contribute to an enhanced understanding of functional changes and eventually optimise conservative management strategies for these patients. Trial registration ClinicalTrials.gov Protocol Registration System: ClinicalTrials.gov ID NCT01839669
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Affiliation(s)
- Angela Blasimann
- Bern University of Applied Sciences, Health, Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Patric Eichelberger
- Bern University of Applied Sciences, Health, Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Yvonne Brülhart
- Bern University of Applied Sciences, Health, Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Isam El-Masri
- Salem-Spital, Foot Surgery, Schänzlistrasse 39, 3013 Bern, Switzerland
| | - Gerhard Flückiger
- Sonnenhofspital, Foot Surgery, Buchserstrasse 30, 3006 Bern, Switzerland
| | - Lars Frauchiger
- Spital STS AG, Orthopaedics & Traumatology, Krankenhausstrasse 12, 3600 Thun, Switzerland
| | - Martin Huber
- Outpatient Clinic for Foot Surgery Bern, Schänzlistrasse 33, 3013 Bern, Switzerland
| | - Martin Weber
- Siloah, Clinic for Orthopaedics and Traumatology, Worbstrasse 316, 3073 Gümligen bei Bern, Switzerland
| | - Fabian G Krause
- Department of Orthopaedic Surgery, University of Bern, Inselspital, Freiburgstrasse, 3010 Bern, Switzerland
| | - Heiner Baur
- Bern University of Applied Sciences, Health, Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
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Formica M, Santolini F, Alessio-Mazzola M, Repetto I, Andretta A, Stella M. Closed Medial Malleolar Multifragment Fracture With a Posterior Tibialis Tendon Rupture: A Case Report and Review of the Literature. J Foot Ankle Surg 2015; 55:832-7. [PMID: 25977150 DOI: 10.1053/j.jfas.2015.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Indexed: 02/03/2023]
Abstract
Ankle fractures represent an exciting field of traumatology because of the wide variety of clinical presentations, injury mechanisms, and treatment options. Rupture of the posterior tibialis tendon (PTT) with ankle fracture can occur during trauma that involves pronation and external rotation of the foot or, less commonly, secondary to direct trauma to the ankle. This tendon injury is uncommon and probably misdiagnosed in many cases, because of the difficult clinical examination secondary to the pain and swelling. The identification and early treatment of PTT tears is essential for good functional outcomes to prevent the main mid- to long-term complication of disabling acquired flatfoot due to tendon failure. In the present report, we provide a review of the published data regarding ankle fractures associated with PTT rupture and describe our experience with a case of a multifragment medial malleolus fracture and complete rupture of the PTT diagnosed intraoperatively and surgically treated in a 34-year-old male, with 2.5 years of follow-up.
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Affiliation(s)
| | | | | | | | | | - Marco Stella
- Ortopaedic and Traumatology Unit, IRCCS S. Martino IST, Genoa, Italy
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26
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Bubra PS, Keighley G, Rateesh S, Carmody D. Posterior tibial tendon dysfunction: an overlooked cause of foot deformity. J Family Med Prim Care 2015; 4:26-9. [PMID: 25810985 PMCID: PMC4367001 DOI: 10.4103/2249-4863.152245] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Posterior tibial tendon dysfunction is the most common cause of adult acquired flatfoot. Degenerative changes in this tendon, lead to pain and weakness and if not identified and treated will progress to deformity of the foot and degenerative changes in the surrounding joints. Patients will complain of medial foot pain, weakness, and a slowly progressive foot deformity. A “too many toes” sign may be present and patients will be unable to perform a single heal raise test. Investigations such X-ray, ultrasound and magnetic resonance imaging will help stage the disease and decide on management. The optimal manage may change based on the progression of deformity and stage of disease. Early identification and prompt initiation of treatment can halt progression of the disease. The purpose of this article is to examine the causes, signs, symptoms, examinations, investigations and treatment options for posterior tibial tendon dysfunction.
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Affiliation(s)
| | - Geffrey Keighley
- Mona Vale Hospital, 1 Coronation Drive, Mona Vale NSW, Australia
| | - Shruti Rateesh
- Mona Vale Hospital, 1 Coronation Drive, Mona Vale NSW, Australia
| | - David Carmody
- Mona Vale Hospital, 1 Coronation Drive, Mona Vale NSW, Australia
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Arthroscopic treatment for posterior tibial tendon lesions with a posterior approach. Knee Surg Sports Traumatol Arthrosc 2015; 23:879-83. [PMID: 23974632 DOI: 10.1007/s00167-013-2629-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 08/18/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate clinical results of arthroscopic treatment for posterior tibial tendon (PTT) lesions using a posterior approach. METHODS Sixteen patients with PTT lesions underwent arthroscopic treatment using a posterior approach. After routine posterior arthroscopy to expose the posterior tibiotalar compartment, the posterior subtalar compartment, and the flexor hallucis longus tendon, the shaver was then moved through the flexor hallucis longus tendon to detect and treat the PTT lesion, including synovectomy, debridement, and repair of the PTT. American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS) scale and visual analog scale (VAS) for subjective satisfaction were used to evaluate pre- and post-operative clinical results. RESULTS Fifteen patients (94 %) (15 ankles) were followed for a mean of 26 ± 10 months. No patients experienced vascular or nerve complications during or after the operation. Mean AOFAS score improved from 49 ± 12 points preoperatively to 84 ± 8.5 points post-operatively (p = 0.000). Mean VAS improved from 6.2 ± 1.7 preoperatively to 2.4 ± 1.3 post-operatively (p = 0.000). There were three patients (20 %) with excellent outcomes, eight patients (53 %) with good outcomes, three patients (20 %) with fair outcomes, and one patient (7 %) with a poor outcome at follow-up. CONCLUSIONS A posterior arthroscopic approach can provide a safe, reliable technique for detecting and treating PTT lesions and a satisfactory surgical outcome. The technique is an alternative to PTT tendoscopy.
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Trividi M, Brown E, Lese A, Katz LD. Lateral dislocation and incarceration of the posterior tibial tendon through the distal tibiofibular syndesmosis. Skeletal Radiol 2014; 43:1175-8. [PMID: 24671259 DOI: 10.1007/s00256-014-1859-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 02/18/2014] [Accepted: 02/27/2014] [Indexed: 02/02/2023]
Abstract
A case of acute, traumatic, lateral dislocation of the posterior tibial tendon is presented as a unique pattern of posterior tibial tendon dislocation. Several attempts at both closed and open reduction were required to relocate the tendon and reduce the fracture-dislocation. This case is being presented to demonstrate the use of cross-sectional imaging to both recognize the initial bony injury and to identify tendon anatomy and pathology that may not be seen in the operating room with limited visualization.
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Affiliation(s)
- Mitesh Trividi
- Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06518, USA
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29
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Martinelli N, Bonifacini C, Bianchi A, Moneghini L, Scotto G, Sartorelli E. Acute rupture of the tibialis posterior tendon without fracture: a case report. J Am Podiatr Med Assoc 2014; 104:298-301. [PMID: 24901592 DOI: 10.7547/0003-0538-104.3.298] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The acute rupture of the tibialis posterior (TP) tendon, compared to an acute rupture of the Achilles tendon, is a quite uncommon disease to be diagnosed in the emergency department setting. In most cases symptoms related to a TP dysfunction, like weakness, pain along the course of the tendon, swelling in the region of the medial malleolus, and the partial or complete loss of the medial arch with a flatfoot deformity precede the complete rupture of the tendon. In this case report, we describe an acute rupture of the TP tendon following a pronation-external rotation injury of the ankle with no association of a medial malleolus fracture and with no history of a prior flatfoot deformity or symptoms.
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Affiliation(s)
- Nicolò Martinelli
- Istituto di Ricerca e Cura a Carattere (IRCCS) Galeazzi, Ankle and Foot Surgery, Milan, Italy
| | - Carlo Bonifacini
- Istituto di Ricerca e Cura a Carattere (IRCCS) Galeazzi, Ankle and Foot Surgery, Milan, Italy
| | - Alberto Bianchi
- Istituto di Ricerca e Cura a Carattere (IRCCS) Galeazzi, Ankle and Foot Surgery, Milan, Italy
| | | | - Gennaro Scotto
- Istituto di Ricerca e Cura a Carattere (IRCCS) Galeazzi, Ankle and Foot Surgery, Milan, Italy
| | - Elena Sartorelli
- Istituto di Ricerca e Cura a Carattere (IRCCS) Galeazzi, Ankle and Foot Surgery, Milan, Italy
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Adult-acquired flatfoot deformity and age-related differences in foot and ankle kinematics during the single-limb heel-rise test. J Orthop Sports Phys Ther 2014; 44:283-90. [PMID: 24568257 DOI: 10.2519/jospt.2014.4939] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional laboratory study. OBJECTIVE To compare single-limb heel-rise performance and foot-ankle kinematics between persons with stage 2 adult-acquired flat foot deformity (AAFD) and healthy controls. BACKGROUND The inability to perform a single-limb heel rise is considered a positive functional diagnostic test for AAFD. However, which foot motions contribute to poor performance of this task are not known. METHODS Fifty individuals participated in this study, 20 with stage 2 AAFD (mean ± SD age, 57.6 ± 11.3 years), and 15 older participants (age, 56.8 ± 5.3 years) and 15 younger participants (age, 22.2 ± 2.4 years) without AAFD as control groups. Forefoot (sagittal plane) and rear foot (sagittal and frontal planes) kinematics were collected using a 3-D motion analysis system. Heel-rise performance (heel height) and kinematics (joint angles, excursions) were evaluated. One-way and 2-way analyses of variance were used to examine differences in heel-rise performance and kinematics between groups. RESULTS Individuals with AAFD and older controls demonstrated lower heel-rise height than those in the younger control group (P<.001). Persons with AAFD demonstrated higher degrees of first metatarsal dorsiflexion (P<.001), lower ankle plantar flexion (P<.001), and higher subtalar eversion (P = .027) than those in the older control group. Persons with AAFD demonstrated lower ankle excursion (P<.001) and first metatarsal excursion (P<.001) than those in the older control group, but no difference in subtalar excursion (P = .771). CONCLUSION Persons with stage 2 AAFD did not achieve sufficient heel height during a single-leg heel rise. Both forefoot and rear foot kinematics in the sagittal plane, as opposed to the frontal plane, contributed to the lower heel height in participants with stage 2 AAFD. Older controls demonstrated lower heel-rise height than younger controls, indicating that clinical expectations of heel-rise performance may need to be adjusted for age.
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31
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Gambardella GV, Donegan R, Caminear DS. Isolated dislocation of the posterior tibial tendon in an amateur snowboarder: a case report. J Foot Ankle Surg 2013; 53:203-7. [PMID: 24361009 DOI: 10.1053/j.jfas.2013.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Indexed: 02/03/2023]
Abstract
Isolated dislocation of the posterior tibial tendon is an uncommon pathologic entity that typically occurs in the setting of acute trauma. The diagnosis remains challenging and is often delayed second to the rarity of the injury and symptoms similar to that of medial ankle sprains and other routinely diagnosed injuries about the ankle. The factors that predispose this tendon to dislocation include a hypoplastic retromalleolar groove, flexor retinaculum insufficiency, chronic repetitive trauma, and a structural abnormality from a previous medial malleolar fracture, or a combination thereof. Dislocation has also been cited as a complication of multiple local steroid injections and tarsal tunnel release. The mechanism of injury appears to involve forced dorsiflexion and eversion of the ankle when the posterior tibial tendon is contracted. Most cases do not respond well to conservative treatment and will require surgery to restore function and eliminate symptoms. We report a case of posterior tibial tendon dislocation related to a snowboarding injury and offer our technique for surgical correction.
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Affiliation(s)
- Gabriel V Gambardella
- New Haven Foot Surgeons/Milford Podiatry Associates, New Haven, CT; and Attending Podiatric Surgeon, Yale-New Haven Hospital, New Haven, CT
| | - Ryan Donegan
- Postgraduate Year 2 Resident, Department of Podiatric Medicine and Surgery, Yale-New Haven Hospital/DVA Healthcare System, Hamden, CT
| | - David S Caminear
- Connecticut Orthopaedic Specialists, Hamden, CT; Section Chief, Department of Podiatric Surgery, Yale-New Haven Hospital, Saint Raphael Campus, New Haven, CT; and Assistant Clinical Professor, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
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Abstract
BACKGROUND Although not well understood, foot kinematics are changed with hallux valgus. OBJECTIVE The purpose of this study was to examine tarsal kinematics in women with hallux valgus deformity. DESIGN A prospective, cross-sectional design was used. METHODS Twenty women with (n=10) and without (n=10) deformity participated. Data were acquired with the use of a magnetic resonance scanner. Participants were posed standing to simulate gait, with images reconstructed into virtual bone datasets. Measures taken described foot posture (hallux angle, intermetatarsal angle, arch angle). With the use of additional computer processes, the image sequence was then registered across gait conditions to compute relative tarsal position angles, first-ray angles, and helical axis parameters decomposed into X, Y, and Z components. An analysis of variance model compared kinematics between groups and across conditions. Multiple regression analysis assessed the relationship of arch angle, navicular position, and inclination of the first-ray axis. RESULTS Both the hallux and intermetatarsal angles were larger with deformity; arch angle was not different between groups. The calcaneus was everted by ≥6.6 degrees, and the first ray adducted (F=44.17) by ≥9.3 degrees across conditions with deformity. There was an interaction (F=5.06) for the first-ray axis. Follow-up comparisons detected increased inclination of the first-ray axis over middle stance compared with late stance in the group with deformity. LIMITATIONS Gait was simulated, kinetics were not measured, and sample size was small. CONCLUSIONS There were group differences. Eversion of the calcaneus and adduction of the first ray were increased, and the first-ray axis was inclined 24 degrees over middle stance in women with deformity compared with 6 degrees in control participants. Results may identify risk factors of hallux valgus and inform nonoperative treatment (orthoses, exercise) strategies.
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Savage-Elliott I, Murawski CD, Smyth NA, Golanó P, Kennedy JG. The deltoid ligament: an in-depth review of anatomy, function, and treatment strategies. Knee Surg Sports Traumatol Arthrosc 2013; 21:1316-27. [PMID: 22878436 DOI: 10.1007/s00167-012-2159-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 07/26/2012] [Indexed: 12/23/2022]
Abstract
PURPOSE A literature review of the deltoid ligament was conducted, examining the current literature on anatomy, function, and treatment strategies. In particular, anatomical inconsistencies within the literature were evaluated, and detailed anatomical dissections are presented. METHODS A literature search was conducted on PubMed using keywords relevant to the deltoid ligament in the ankle and medial ankle instability. Primary research articles, as well as appropriate summary articles, were selected for review. RESULTS While it is well defined that the deltoid is contiguous and divided into one superficial and one deep portion, the creation of the individual fibres may be artificial. Furthermore, while improvements in imaging techniques and arthroscopy have not led to a consensus on the anatomy of the ligament, they may help improve recognition of deltoid injuries. Once identified, the majority of deltoid injuries can be treated via conservative treatment. However, reparative and reconstructive treatment strategies can also be used for complex acute injuries or chronic medial ankle instability. CONCLUSION Given the continuing evolution of the anatomical understanding of the ligament, the current treatment protocol for deltoid injuries requires further standardization, with an emphasis on proper diagnosis.
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Ribbans WJ, Garde A. Tibialis posterior tendon and deltoid and spring ligament injuries in the elite athlete. Foot Ankle Clin 2013; 18:255-91. [PMID: 23707177 DOI: 10.1016/j.fcl.2013.02.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The tibialis posterior tendon and the spring and deltoid ligament complexes combine to provide dynamic and passive stabilization on the medial side of the ankle and hindfoot. Some of the injuries will involve acute injury to previous healthy structures, but many will develop insidiously. The clinician must be aware of new treatment strategies and the level of accompanying scientific evidence regarding injuries sustained by athletes in these areas, while acknowledging that more traditional management applied to nonathletic patients is still likely to be appropriate in the setting of treatment for elite athletes.
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Affiliation(s)
- William John Ribbans
- The University of Northampton, School of Health, Park Campus, Northampton NN2 7AL, UK.
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Roussignol X, Lagrave B, Berthiaux S, Duparc F, Dujardin F. Posterior tibial tendoscopy: Description of an accessory proximal portal and assessment of tendon vascularization lesion according to portal. Foot Ankle Surg 2013; 19:22-6. [PMID: 23337272 DOI: 10.1016/j.fas.2012.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 07/11/2012] [Accepted: 08/12/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Posterior tibial tendoscopy was codified in 1997 by Van Dijck, who described a portal between 1.5 and 2cm proximally and distally to the tip of the medial malleolus. However, this approach does not allow proximal exploration of the posterior tibial tendon (PTT). We here describe an accessory portal 7cm proximal to the medial malleolus, enabling complete PTT exploration. METHODS Posterior tibial tendoscopy was performed on 12 cadaver specimens, mapping PTT exploration and vascularization. RESULTS The accessory portal enabled the whole PTT to be explored, from the myotendinous junction to the entry into the retromalleolar groove. PTT observation quality was improved compared to using a submalleolar portal. Dissection confirmed systematic presence of a vincula on the posterior side of the tendon, connected to the flexor digitorum longus (FDL) tendon, containing collateral vessels of the posterior tibial artery. None of these elements were damaged by the tendoscopy as long and the scope and motorized instruments were not rotated on the posterior side of the supramalleolar part of the PTT. CONCLUSIONS This accessory entry portal provides complete PTT exploration without the risk of neurovascular bundle lesion.
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Affiliation(s)
- X Roussignol
- Department of Orthopedic Surgery, Charles Nicolle University Hospital, Rouen, France.
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Cabral P, Paulino C, Takahashi R, Clopton P, Resnick D. Correlation of morphologic and pathologic features of the various tendon groups around the ankle: MR imaging investigation. Skeletal Radiol 2013; 42:1393-402. [PMID: 23820630 PMCID: PMC3751327 DOI: 10.1007/s00256-013-1650-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 05/05/2013] [Accepted: 05/06/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if a statistical association exists between abnormalities in one ankle tendon group (i.e., peroneal, medial flexor, or Achilles) and those in another. MATERIALS AND METHODS A retrospective analysis of 1.5-T and 3-T MR ankle examinations in 100 patients conducted between November 1, 2011 and April 1, 2012 was performed. The cross-sectional areas and diameters of the ankle tendons-Achilles (ACH), peroneus brevis (PB) and longus (PL), tibialis posterior (TP), flexor digitorum longus (FDL), and flexor hallux longus (FHL)-were measured, and the results were correlated to determine any association with the presence of qualitative abnormalities (tenosynovitis, tendinosis, and tendon tearing). RESULTS Subjects with larger diameters of the ACH tendon also revealed larger PL, TP, FDL, and FHL tendon diameters and sectional areas. Furthermore, subjects with larger PL tendons generally revealed larger flexor tendons and the same was also true when medial compartment tendons were individually assessed and measurements compared among the three of them. There was a statistically significant association with regard to the presence of tendon abnormalities (tendinosis, tenosynovitis, and tearing) in both the peroneal and medial flexor tendons. The presence of an abnormality in the ACH tendon correlated strongly with increasing diameters and areas of all the other ankle tendons except for the PB tendon. CONCLUSIONS There is an association between quantitative and qualitative abnormalities of one group of tendons when compared with the others with respect to the ACH, medial flexor, and peroneal tendons of the ankle, which is perhaps explained by a retinacular and fascial complex that anatomically connects the three groups.
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Affiliation(s)
- Pedro Cabral
- Department of Radiology, Prof. Doutor Fernando Fonseca Hospital, IC 19 - Venteira, 2720-276 Amadora, Portugal
| | - Cláudia Paulino
- Department of Radiology, Coimbra University Hospital, Praceta Mota Pinto, 3000-075 Coimbra, Portugal
| | - Rogério Takahashi
- Centro de Diagnósticos Brasil, Rua Diogo de Faria, 470/490 - Vila Clementino, São Paulo, SP Brazil 04037001
| | - Paul Clopton
- Research & Development Service, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161 USA
| | - Donald Resnick
- UCSD Teleradiology Center, 8899 University Center Lane, Suite 370, San Diego, CA 92122 USA
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Miyamoto W, Takao M, Yamada K, Yasui Y, Matsushita T. Reconstructive surgery using interference screw fixation for painful accessory navicular in adult athletes. Arch Orthop Trauma Surg 2012; 132:1423-7. [PMID: 22744816 DOI: 10.1007/s00402-012-1574-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To examine the effectiveness of a new technique for reattaching the posterior tibial tendon (PTT) using a bone tunnel and interference screw after resection of the accessory navicular for painful accessory navicular (type II) in adult athletes. METHODS Ten adult athletes (7 male, 3 female; mean age 30 years, range 23-45) underwent reconstruction using a bone tunnel with an interference screw for a painful accessory navicular. All patients complained of pain on the medial aspect of the foot after eversion sprain during sports activities and radiographs revealed type II accessory navicular. Clinical evaluation with the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) and visual analogue scale (VAS) before surgery was compared with that at most recent follow up (mean 30 months, range 24-39). RESULTS Mean AOFAS score improved from a preoperative 62.8 ± 2.9 points (range 61-82) to a postoperative 92.1 ± 7.0 points (range 83-100; p < 0.01). Furthermore, mean VAS score improved from a preoperative 92.5 ± 5.4 points (range 85-100) to a postoperative 4.5 ± 3.8 points (range 0-10; p < 0.01). All patients could return to full sports activity at a mean of 14 weeks (range 12-18) after surgery. CONCLUSIONS The presented technique reconstructs the bone-tendon interface of the PTT at the primary navicular with sufficient fixation after resection of the accessory navicular, which preserves the strength of the PTT in adult athletes with an intractably painful accessory navicular.
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Affiliation(s)
- Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo 173-8605, Japan.
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31824bc119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Corps AN, Robinson AHN, Harrall RL, Avery NC, Curry VA, Hazleman BL, Riley GP. Changes in matrix protein biochemistry and the expression of mRNA encoding matrix proteins and metalloproteinases in posterior tibialis tendinopathy. Ann Rheum Dis 2012; 71:746-52. [PMID: 22241901 PMCID: PMC3329235 DOI: 10.1136/annrheumdis-2011-200391] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objectives Adult-acquired flat foot secondary to a dysfunctional posterior tibialis tendon (PTT) is often treated by surgical transfer of the flexor digitorum longus tendon (FDLT). In this study, the authors compared normal PTT, stage II dysfunctional PTT and replacement FDLT, aiming to define changes in collagen modification, glycosaminoglycan (GAG) and the expression of matrix and metalloproteinase mRNA. Methods Normal PTTs were obtained from patients with no history of tendon problems. Samples of dysfunctional PTT and replacement FDLT tissue were obtained from patients undergoing surgical reconstruction. Tissue samples were analysed for total collagen and GAG, pentosidine and collagen cross-links. Total RNA was assayed for mRNA encoding matrix proteins and metalloproteinases, using real-time reverse transcription PCR. Differences between clinical groups were assessed using non-parametric statistics. Results Dysfunctional PTT contained higher levels of GAG and lower levels of pentosidine than normal PTT or FDLT. In contrast, collagen in FDLT contained fewer ketoimine and more aldimine cross-links than either normal or dysfunctional PTT. mRNA encoding types I and III collagens, aggrecan, biglycan, matrix metalloproteinase (MMP)-2, -13 and -23, and a disintegrin and metalloproteinase (ADAM)-12L each showed increased levels in dysfunctional PTT compared with either normal PTT or (except MMP-13) FDLT. In contrast, MMP-3 and ADAM with thrombospondin domain (ADAMTS)-5 mRNA were lower in both dysfunctional PTT and FDLT than in normal PTT, while ADAMTS-1 mRNA was lower in dysfunctional PTT than in FDLT. Conclusions Stage II dysfunctional PTT shows biochemical and molecular changes consistent with a chronic remodelling of the extracellular matrix, rather than rupture, while the replacement FDLT resembles normal PTT in many, but not all, parameters.
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Affiliation(s)
- Anthony N Corps
- Rheumatology Research Unit, Addenbrooke's Hospital, Cambridge, UK
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