scholarly journals Ultrasound Guidance in Performing a Tendoscopic Surgery to Treat Posterior Tibial Tendinitis: A Useful Tool?

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Akinobu Nishimura ◽  
Shigeto Nakazora ◽  
Aki Fukuda ◽  
Ko Kato ◽  
Akihiro Sudo
Keyword(s):  
External Rotation ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Posterior Tibial Tendon ◽  
Ankle Pain ◽  
Posterior Tibial Tendon Dysfunction ◽  
Posterior Tibial ◽  
One Year ◽  
Stage 1 ◽  
Pronation External Rotation

A 25-year-old man with a pronation-external rotation type of fracture was surgically treated using a fibular plate. Five years later, he underwent resection of bone hyperplasia because of the ankle pain and limitation of range of motion. Thereafter, the left ankle became intermittently painful, which persisted for about one year. He presented at the age of 43 with persistent ankle pain. Physical and image analysis findings indicated a diagnosis of posttraumatic posterior tibial tendinitis, which we surgically treated using tendoscopy. Endoscopic findings showed tenosynovitis and fibrillation on the tendon surface. We cleaned and removed the synovium surrounding the tendon and deepened the posterior tibial tendon groove to allow sufficient space for the posterior tibial tendon. Full weight-bearing ambulation was permitted one day after surgery and he returned to his occupation in the construction industry six weeks after surgery. The medial aspect of the ankle was free of pain and symptoms at a review two years after surgery. Although tendoscopic surgery for stage 1 posterior tibial tendon dysfunction has been reported, tendoscopic surgery to treat posttraumatic posterior tibial tendinitis has not. Our experience with this patient showed that tendoscopic surgery is useful not only for stage 1 posterior tibial dysfunction, but also for posttraumatic posterior tibial tendinitis.

scholarly journals Posterior Tibial Tendon Dysfunction

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Jason Bariteau ◽  
Douglas Robertson ◽  
William Carpenter
Keyword(s):  
Clinical Diagnosis ◽  
Fluid Volume ◽  
Posterior Tibial Tendon ◽  
Ankle Pain ◽  
Posterior Tibial Tendon Dysfunction ◽  
Cross Sectional ◽  
Posterior Tibial ◽  
Sheath Fluid ◽  
Stage 1 ◽  
Tendon Pathology

Category: Hindfoot Introduction/Purpose: Stage 1 posterior tibial tendon dysfunction (PTTD) may be present without intra-substance tendon pathology. We hypothesize that in individuals with the clinical diagnosis of Stage 1 PTTD, with no MRI-detectable intra-substance tendon pathology, that sheath fluid amount is a confirmatory finding of PTTD. This purpose of this study was to quantify the amount of PTT sheath fluid in 1) individuals with the clinical diagnosis of Stage 1 PTTD and no MRI-detectable intra-substance tendon pathology and compare to controls with medial ankle pain (causes other) also without MRI-detectable intra-substance PTT pathology, and 2) test if there was a sheath fluid measurement predictive of the clinical diagnosis of PTTD. Methods: 326 individuals with medial ankle pain, no intra-substance PTT pathology, were studied, 48 with the clinical diagnosis of Stage 1 PTT dysfunction and 278 with medial ankle pain, causes other. Geometric methods defined MRI-based sheath fluid volume, maximum cross-sectional fluid area, and maximum fluid width. Fluid measurements were compared between groups and a predictive measurement calculated to identify individuals with PTTD. Measurement reliability was tested. Results: Individuals with PTT dysfunction had larger PTT sheath fluid volume, area, and width than controls (p’s < 0.001). An 9 mm threshold maximum fluid width was associated with PTTD (sensitivity 84%, specificity 85%). Measurements were reliable (p’s <0.03). Conclusion: The amount of PTT sheath fluid, in individuals with medial ankle pain and no intra-substance PTT pathology, was associated with Stage 1 PTTD and a maximum PTT sheath fluid width of > 9 mm predicted PTTD. This is clinically significance as MRI-detected sheath fluid can now be used as a confirmatory finding in individuals with the clinical diagnosis of Stage 1 PTTD who do not have MRI-detectable intra-substance pathology

scholarly journals 3-D Morphometric Analysis of Talocalcaneal Joint in Stage II Posterior Tibial Tendon Dysfunction

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0017
Author(s):  
Jarrett D. Cain ◽  
Gregory Lewis ◽  
Allen Kunselman
Keyword(s):  
Subtalar Joint ◽  
Weight Bearing ◽  
Three Dimensional ◽  
Stage Ii ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Morphometric Measurements ◽  
Posterior Tibial ◽  
Computed Tomography Images ◽  
Joint Contact Pressure

Category: Hindfoot Introduction/Purpose: Posterior Tibial Tendon Dysfunction (PTTD) is common disorder that can lead to changes in function during the gait cycle due to decreased arch, increased hindfoot valgus, and forefoot abduction. These kinematic changes can have a structural impact on the joints throughout the foot. While previous studies have evaluated anatomical three-dimensional (3D) position of the subtalar joint, the purpose of this study was to perform morphological analysis of the anterior, middle and posterior facets in patients with stage II posterior tibial tendon dysfunction compared to normal controls. Methods: Clinical computed tomography images from 10 matched feet (i.e., 10 normal and 10 stage II PTTD) were obtained and used for 3D reconstruction in Mimics software (Materialise). From the3D reconstructions, morphometric evaluations of the subtalar joint were completed including 3D anatomic point placement and measurements of the length and width of the anterior, middle and posterior facets (Fig. 1) by 3 independent evaluators. Evaluators were blinded to experimental groups and to one another’s measurements. A linear mixed-effects model was used to assess the differences between control and PTTD subtalar joints with respect to morphometric measurements (mm). The concordance correlation coefficient (CCC) was used to assess the agreement between the 3 evaluators with respect to their recorded morphometric measurements per location (e.g., anterior, middle, posterior). Results: Although the mean distance of the length and width of the middle facet trended higher in the stage II PTTD compared to controls, this difference was not statistically significant (Table 1). Similarly, there was no difference detected between control and PTTD with respect to morphometric measurements in the anterior and posterior facets (Table 1). The agreement among the 3 evaluators with respect to morphometric measurements was the strongest in the length and width of the middle facets. Conclusion: Stage II posterior tibial tendon dysfunction has been shown to cause increase subtalar joint kinematics, joint contact pressure. Based on the results, there is a positive correlation involving morphologic changes of subtalar joint with the middle facet measurements being larger in the PTTD group. Further studies are needed with weight bearing CT scans in correlation with advance stages of posterior tibial tendon dysfunction.

scholarly journals Morphometric Measurements of the Calcaneus in Adults with Stage IIb, Posterior Tibial Tendon Dysfunction

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0050
Author(s):  
Kempland Walley ◽  
Evan Roush ◽  
Chris Stauch ◽  
Allen Kunselman ◽  
Kaitlin Saloky ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Pediatric Population ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Morphometric Measurements ◽  
Anterior Process ◽  
Lateral Column ◽  
Posterior Tibial

Category: Hindfoot Introduction/Purpose: The pathophysiology of adult-acquired flatfoot deformity (AAFD) is not fully explained by degeneration of the posterior tibial tendon alone. While a shortened or dysplastic lateral column has been implicated in flatfoot deformity in pediatric population, there is no study that has quantified the degree of shortening or dysplasia in adults with a stage IIb flatfoot deformity, or if any exists at all. The purpose of this study was to use reconstructive 3D modeling from computed tomography (CT) scans of the calcaneus in order to perform three-dimensional morphometric measurements of the lateral column in patients with stage IIb posterior tibial tendon dysfunction (PTTD) compared to controls in an effort to better understand the morphology of patients with AAFD. Methods: After IRB approval, an institutional radiology database was queried for patients with PTTD who had CT performed between January 2011 and June 2016. Controls were patients receiving CT scan for an intraarticular distal tibia fracture without preexisting foot or calcaneal pathology. Clinical office notes, physical examination, and weight-bearing radiographs were used to identify patients that met clinical criteria for stage IIb PTTD. A 1:1 match was performed using age, laterality, gender, and BMI. Morphometric measurements of the calcanei were performed involving the length of the calcaneal axis (LCA), height of the anterior process (HAP), and length of the anterior process (LAP) (Figure 1). Linear mixed-effects models were used to assess the differences between control and PTTD patients with respect to LAP, HAP, and LCA measurements, with also considering measurements from 3 independent observers. We considered a difference of ± 4 mm as our threshold of clinical significance. Results: Of the 3586 CT within our institutional database, a total of 14 patients were available for reconstruction and analysis. There were no statistical differences detected between patient characteristics or demographics between these groups. On average, the long axis of the calcaneus (LCA) was 3.1 mm shorter (95% confidence interval: 0.43-5.76 mm) in patients with stage IIb PTTD compared to controls (p<0.05). Additionally, the distance from the articular margin of the posterior facet to the anterior process (LAP) was shorter in PTTD patients compared to controls 3.35 mm (p<0.001; 95% confidence interval: 1.82- 4.88). Comparison of observers demonstrated high agreement between LCA and LAP measurements, as illustrated by satisfactory concordance correlation coefficients. Conclusion: Our results support the hypothesis that the calcaneus of adult patients with stage IIb AAFD is, indeed, dysplastic when compared to healthy controls, which further supports the utility of LCL. Analysis of these results, taken together with previous literature, may suggest the use of a smaller graft between 4-6 mm as ideal when performing this procedure.

3D foot kinematic difference in Posterior Tibial Tendon Dysfunction stage II/III and control group

2016 ◽  
Vol 22 (2) ◽  
pp. 11
Author(s):  
S. Wuite ◽  
K. Deschamps ◽  
C. Roels ◽  
M. van de Velde ◽  
F. Staes ◽  
...  
Keyword(s):  
Stage Ii ◽  
Control Group ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Posterior Tibial ◽  
And Control
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