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Abou Diwan R, Badr S, Boulil Y, Demondion X, Maynou C, Cotten A. Presurgical Perspective and Postsurgical Evaluation of Non-Achilles Tendons of the Ankle and Retinaculum. Semin Musculoskelet Radiol 2022; 26:670-683. [PMID: 36791736 DOI: 10.1055/s-0042-1760121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The vast majority of non-Achilles ankle tendinopathies are related to overuse. This article discusses the clinical aspect, imaging appearance, and management of tendinopathies of the lateral, medial, and the anterior compartments with a focus on presurgical perspective and postsurgical evaluation.
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Muacevic A, Adler JR, Patel F, Senn D. Rupture of the Tibialis Posterior Tendon With Associated Bimalleolar Ankle Fracture. Cureus 2022; 14:e31886. [PMID: 36579223 PMCID: PMC9790175 DOI: 10.7759/cureus.31886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 11/27/2022] Open
Abstract
The acute traumatic rupture of the tibialis posterior tendon in association with closed ankle fractures is rare and often under-recognised. If recognised early, outcomes can be excellent. There are 28 known cases in the literature, and we report two further cases associated with bimalleolar ankle fracture dislocation. A 49-year-old presented with valgus deformity at the ankle joint and global tenderness following a work injury as a mechanic. A plain radiograph showed a displaced oblique comminuted fracture of the lateral malleolus with valgus angulation at a syndesmosis, with significant talar shift. The patient underwent open reduction and internal fixation with a seven-hole, one-third tubular plate and screws. A 35-year-old involved in a motorcycle collision with a car presented with swollen left ankle and valgus deformity. Plain radiographs revealed bimalleolar fracture subluxation. Closed reduction was unsuccessful and hence direct medial approach demonstrated a complete rupture of the posterior tendon. The medial malleolus was fixed using lag screws and washers. The tendon was repaired using the modified Kessler technique in both cases. The tibialis posterior plays a significant role in foot and ankle biomechanics due to its broad tendinous insertion. Acute traumatic rupture is rare, as it is protected due to its deep-seated anatomic location within the deep posterior compartment of the leg. Preoperative diagnosis of this injury is challenging and hence this diagnosis is often made intraoperatively. In both cases, there was a retraction of the proximal end beyond incision margins, and this can make tendon rupture difficult to identify intraoperatively as well. Upon identification, assessment of the tendon for degenerative changes was key to deciding upon suitability for primary repair. Despite its rarity, a high index of suspicion should be maintained in fracture dislocation of the ankle joint, especially when the mechanism is known to be pronation-external rotation.
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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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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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Cataldi C, Bacci N, Colasanti GB, Moreschini F, Muratori F, Mondanelli N, Giannotti S. Posterior Tibial Tendon Rupture Associated With Anterolateral Distal Tibial and Medial Malleolar Fracture and a Novel Pattern of Tibiofibular Syndesmotic Injury: A Case Report and Review of the Literature. J Foot Ankle Surg 2021; 59:1066-1071. [PMID: 32360328 DOI: 10.1053/j.jfas.2020.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/12/2020] [Accepted: 02/29/2020] [Indexed: 02/03/2023]
Abstract
A posterior tibial tendon (PTT) rupture associated with ankle fractures is a very rare condition. Ankle pronation and external rotation (PER) movement are the typical traumatic mechanism. This injury is frequently overlooked preoperatively. Early diagnosis and treatment are very important to prevent the serious consequences related to functional PTT insufficiency on biomechanics of the foot. Few cases have been described in the literature that highlight the relationship between PTT rupture and PER type ankle fracture with a medial malleolar fracture. We present a case of a complete PTT rupture in a closed atypical ankle fracture in which a medial malleolar fracture was associated with a very large fragment from the anterolateral distal tibia (Tillaux-Chaput fragment) and a concomitant avulsion fracture from the anteromedial portion of the fibula (Lefort-Wagstaffe fragment), with a novel pattern never described before.
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Affiliation(s)
- Carlo Cataldi
- Resident, Department of Medicine, Surgery and Neurosciences: Section of Orthopedics and Traumatology, University of Siena, Siena, Italy; Resident, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Nicola Bacci
- Orthopedic Consultant, Department of Medicine, Surgery and Neurosciences: Section of Orthopedics and Traumatology, University of Siena, Siena, Italy; Orthopedic Consultant, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Giovanni Battista Colasanti
- Resident, Department of Medicine, Surgery and Neurosciences: Section of Orthopedics and Traumatology, University of Siena, Siena, Italy; Resident, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Fabio Moreschini
- Resident, Department of Medicine, Surgery and Neurosciences: Section of Orthopedics and Traumatology, University of Siena, Siena, Italy; Resident, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Francesco Muratori
- Orthopedic Consultant, Orthopaedic Oncology and Reconstructive Surgery Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Nicola Mondanelli
- Orthopedic Consultant, Department of Medicine, Surgery and Neurosciences: Section of Orthopedics and Traumatology, University of Siena, Siena, Italy; Orthopedic Consultant, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
| | - Stefano Giannotti
- Professor and Chief of Service, Department of Medicine, Surgery and Neurosciences: Section of Orthopedics and Traumatology, University of Siena, Siena, Italy; Professor and Chief of Service, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
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Presentation, Diagnosis, and Nonsurgical Treatment Options of the Anterior Tibial Tendon, Posterior Tibial Tendon, Peroneals, and Achilles. Foot Ankle Clin 2017; 22:677-687. [PMID: 29078822 DOI: 10.1016/j.fcl.2017.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Disorders of the anterior tibial tendon (ATT) are rare, and relatively few series have been described in the literature. Ruptures of the ATT are more common than tendinopathies of the ATT. For those patients with a tendinopathy, initial treatment may include activity and shoe-wear modifications.
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Srinivasan S, Kurup H. Fibular insufficiency fracture: an under-reported complication of advanced tibialis posterior dysfunction. BMJ Case Rep 2017; 2017:bcr-2017-221206. [PMID: 28883012 DOI: 10.1136/bcr-2017-221206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of fibular insufficiency (stress) fracture in a patient with pre-existing asymptomatic advanced tibialis posterior dysfunction. The patient had severe planovalgus (flat foot) deformity but no pain before the injury; hence had never sought any treatment. She was first treated conservatively for the fracture which failed to control the deformity and had ongoing symptoms. She eventually required tibio-talo-calcaneal fusion. To the best of our knowledge, this is the first case report of this condition in the English literature. In patients with severe tibialis posterior dysfunction, weight-bearing axis passes directly from calcaneum to fibula making it vulnerable to fracture. Patients should be made aware of this risk even if they are asymptomatic and encouraged to use orthotic support for protection against insufficiency fractures.
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Affiliation(s)
- Suresh Srinivasan
- Department of Orthopaedics, Pilgrim Hospital, Boston, Lincolnshire, UK
| | - Harish Kurup
- Department of Orthopaedics, Pilgrim Hospital, Boston, Lincolnshire, UK
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