Prevalence of Abnormal Ultrasound Findings in Asymptomatic Posterior Tibial Tendons

Background: Posterior tibial tendon dysfunction (PTTD) is a pathological condition that can cause failure of the posterior tibial tendon (PTT). Initially, patients with PTTD are often asymptomatic, making early identification and treatment challenging. Certain ultrasound (US) characteristics have been implicated in the presence of tendinopathy, but their frequency has yet to be assessed in the PTT. The purpose of this study was to identify and report on the frequency of incidental, or potentially early subclinical, tendinopathic US characteristics in asymptomatic PTTs. Methods: Following institutional review board approval, 150 participants underwent a bilateral-comprehensive US assessment. The resulting images were reviewed and assessed to identify the presence of abnormalities demonstrated to represent tendinopathy. Results: Overall, 266 tendons were assessed and 128 (48.1%) were determined to have at least one tendinopathic trait. Specifically, 51 (19.2%) had circumferential fluid, 69 (25.9%) had noncircumferential fluid, 22 (8.3%) had thickening, 31 (11.7%) had heterogenicity, 19 (7.1%) had hyperemia, and 2 (0.8%) had calcification. Additionally, Caucasian participants were found to be nearly 3 times more likely to have tendinopathic findings when compared with African American participants. Conclusion: Sixty-seven percent of participants and 48.1% of PTTs evaluated had at least one tendinopathic feature identified on US. The prevalence rates of these findings, observed in participants, were as follows: noncircumferential fluid, circumferential fluid, heterogenicity, and thickening. Knowing the frequency of these traits may help clinicians to identify subclinical tendinopathy in the PTT before it progresses to PTTD. Level of Evidence: Level IV, case series.

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Assessment of imaging, pathoanatomy and terminology in posterior tibial tendon dysfunction

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1181 ◽

2020 ◽

Vol 14 (2) ◽

pp. 126-131

Author(s):

Matthew Workman ◽

Nick Saragas ◽

Paulo Ferrao

Keyword(s):

Case Series ◽

Tendon Sheath ◽

Pathological Process ◽

Preoperative Imaging ◽

Research Assessment ◽

Posterior Tibial Tendon ◽

Posterior Tibial Tendon Dysfunction ◽

Mri Findings ◽

Level Of Evidence ◽

Posterior Tibial

Objective: This study aimed to determine damage/change occurring in the posterior tibial tendon of patients undergoing surgery for posterior tibial tendon dysfunction (PTTD) and to correlate preoperative imaging and intraoperative findings with histology to determine the most appropriate investigations for diagnosis. The secondary aim was to clarify terminology used in describing the tendon pathology, to improve descriptive terminology for research, assessment, and treatment of PTTD. Methods: The records of patients who had undergone surgery for stage 2 PTTD were retrospectively reviewed. Cases in which preoperative diagnostic imaging was done and a posterior tibial tendon specimen was sent for histology were included. Ultrasound (US) and MRI findings, surgical notes and histopathological reports were evaluated. Results: Nineteen patients met the inclusion criteria. Fourteen had US showing degenerative changes and synovitis. Five had MRI showing tendon degeneration, with rupture in two cases. Intraoperatively, all tendons showed gross abnormality, with surrounding synovitis. Microscopically, no acute inflammation was noted within any tendon specimens. All had non-specific reactive changes within the visceral synovium. Conclusion: This study confirms clear histological degeneration within the posterior tibial tendon of patients undergoing corrective surgery for PTTD. Preoperative imaging and surgical findings identified tendon sheath synovitis. Pre-operative ultrasound imaging and intraoperative confirmation of PTTD is accurate; thus, histological confirmation is unnecessary. The pathological changes in PTTD have been described as a tendinopathy in the literature. We suggest using the term pantendinopathy, which is a combination of peritendinitis with tendinosis, as it better describes the pathological process. Level of Evidence IV; Therapeutic Studies; Case Series

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Tendoscopic management of posterior tibial tendinitis

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1171 ◽

2020 ◽

Vol 14 (2) ◽

pp. 168-172

Author(s):

Alberto Auellar-Avaroma ◽

Ana Cristina King-Martinez

Keyword(s):

Case Series ◽

Posterior Tibial Tendon ◽

Level Of Evidence ◽

Posterior Tibial ◽

Important Improvement ◽

Number Of Patients ◽

Patient Reported ◽

Vas Scores ◽

Cosmetic Outcomes

Objective: The aim of this study was to present a case series of patients undergoing posterior tibial tendoscopy, assess their clinical outcome, and describe surgical findings and treatment complications. Methods: This is a clinical, retrospective, observational study of 11 consecutive cases of tenosynovitis of the posterior tibial tendon. All 11 patients underwent tendoscopy of the posterior tibial tendon. All procedures were performed by the same surgeon in 2 different hospitals. Minimum follow-up was 2 years. Results: All patients had their preoperative and postoperative AOFAS and VAS scores assessed. Both scores had an important improvement at 12 months that persisted at 24 months. Moreover, 72.72% of the patients were very satisfied with the procedure, and no patient reported to be dissatisfied. Additionally, 90.91% of the patients had no postoperative complications. The present results are consistent with those previously reported in the literature. Conclusion: Endoscopic or tendoscopic repair of the posterior tibial tendon is a simple and reproducible procedure that provides good functional and cosmetic outcomes with a low complication rate. It is important to increase the number of patients in this series in order to expand our conclusions. Level of Evidence IV; Therapeutic Studies; Case Series.

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A Novel Medial Malleolar Osteotomy Technique for the Treatment of Osteochondral Lesions of the Talus

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121989988 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712198998

Author(s):

Yong Hu ◽

Cheng Yue ◽

Xiucun Li ◽

ZhengXun Li ◽

Dongsheng Zhou ◽

...

Keyword(s):

Case Series ◽

High Rate ◽

Osteochondral Lesions ◽

Medial Malleolus ◽

Posterior Tibial Tendon ◽

The Novel ◽

Level Of Evidence ◽

Posterior Tibial ◽

Medial Malleolar Osteotomy ◽

Osteotomy Technique

Background: The current techniques for medial malleolar osteotomy may lead to posterior tibial tendon injury and have a high rate of malunion. Purpose: To describe a novel partial step-cut medial malleolar osteotomy technique and evaluate its technical feasibility and its advantages compared with traditional methods. Study Design: Case series; Level of evidence, 4. Methods: The novel technique consisted of osteotomy of the anterior one-third to two-thirds of the medial malleolus. A total of 19 ankles (18 patients) with osteochondral lesions of the talus underwent the novel osteotomy technique before osteochondral reconstruction. All patients were evaluated for more than 2 years. Radiographs were analyzed for postoperative displacement and malunion, and postoperative ankle function was evaluated according to the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and the visual analog scale (VAS) for pain. Results: The partial step-cut osteotomy technique was able to provide adequate intra-articular exposure without disturbing the posterior tibial tendon. The 19 ankles healed at a mean of 7.3 ± 1.5 weeks (range, 6-12 weeks). There was slight incongruence in 4 ankles, with a displacement of 1.0 ± 0.1 mm proximally and 0.3 ± 0.1 mm medially. The mean postoperative AOFAS and VAS scores improved compared with preoperatively, from 54.2 ± 12.1 to 84.6 ± 6.6 and from 6.4 ± 1.0 to 1.8 ± 1.3, respectively ( P < .001 for both). No intraoperative tendon injuries were observed. Conclusion: Results indicated that partial step-cut osteotomy is a reliable and effective method for providing enough exposure, avoiding displacement after reduction, and not disturbing the anatomic structures behind the medial malleolus.

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Combined Spring and Deltoid Ligament Repair in Adult-Acquired Flatfoot

Foot & Ankle International ◽

10.1177/1071100718770132 ◽

2018 ◽

Vol 39 (8) ◽

pp. 903-907 ◽

Cited By ~ 14

Author(s):

Caio Nery ◽

André Vitor Kerber C. Lemos ◽

Fernando Raduan ◽

Nacime Salomão B. Mansur ◽

Daniel Baumfeld

Keyword(s):

Case Series ◽

Deltoid Ligament ◽

Posterior Tibial Tendon ◽

Retrospective Case ◽

Level Of Evidence ◽

Posterior Tibial ◽

Novel Technique ◽

Spring Ligament ◽

Tissue Healing ◽

Internal Brace

Background: Adult-acquired flatfoot deformity (AAFD) is usually due to a combination of mechanical failure of the osteoligamentous complex that maintains the medial longitudinal arch of the foot and attenuation or complete tear of the posterior tibial tendon. Magnetic resonance imaging studies in patients with flatfoot deformities have reported the posterior tibial tendon to be pathologic in up to 100% of patients, the spring ligament in up to 87%, and the deltoid ligament in 33%. Many studies in the literature describe reconstruction of the spring ligament or the deltoid ligament associated with AAFD, but there is no study in which both (spring and deltoid) ligaments are reconstructed at the same time. We describe a novel technique to reconstruct the deltoid ligament and the spring ligament at the same time. Methods: We described the technique and evaluated 10 consecutive patients with AAFD and insufficient ankle and midfoot ligaments. Results: We found no postoperative complications, stiffness, or loss of correction. Conclusion: We present a novel technique to reconstruct the failed deltoid and spring ligament during flatfoot correction. It is unique in that it uses internal brace augmentation with FiberTape® to help and protect the soft tissue healing. Level of Evidence: Level IV, retrospective case series.

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Tendoscopic treatment of acute posterior tibial tendon dysfunction: case report

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2021.v15.1570 ◽

2021 ◽

Vol 15 (3) ◽

pp. 265-268

Author(s):

Daniel Saraiva ◽

Markus Knupp ◽

André Sá Rodrigues ◽

Tiago Mota Gomes ◽

Xavier Martin Oliva

Keyword(s):

Posterior Tibial Tendon ◽

Foot And Ankle ◽

Posterior Tibial Tendon Dysfunction ◽

Level Of Evidence ◽

Hindfoot Alignment ◽

Rheumatoid Patient ◽

Posterior Tibial ◽

Foot Arch ◽

Magnetic Resonance Imaging Mri

We present a case of a rheumatoid patient presenting with acute signs of posterior tibial tendon dysfunction (PTTD). Magnetic resonance imaging (MRI) results were inconclusive regarding the grade of posterior tibial tendon (PTT) tear. We performed posterior tibial tendoscopy, releasing all tendon adherences, and accomplished complete synovectomy. By the end of the procedure, we observed PTT integrity, normal excursion, and mild tendinosis. At 24-month follow-up, the Visual Analog Scale for pain (VAS-Pain) decreased from 9 (preoperatively) to 1. The Foot and Ankle Outcome Score (FAOS) increased from 16% (preoperatively) to 94%. Clinically, the patient had a symmetric bilateral heel rise test and no pain over the course of the PTT. A standard radiographic assessment demonstrated a normal foot arch and hindfoot alignment. This report illustrates how posterior tibial tendoscopy can simultaneously provide accurate diagnosis and surgically address acute PTTD on a rheumatoid patient, relieving symptoms and improving midterm clinical scores. Level of Evidence V; Therapeutic Studies; Expert Opinion.

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Postoperative evaluation of posterior tibial tendon transfer

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2018.v12.787 ◽

2018 ◽

Vol 12 (2) ◽

pp. 145-149

Author(s):

Larissa Miranda Xavier Vieira ◽

Rodrigo Barra Caiado Fleury ◽

Bruno Severino Nunes ◽

Jefferson Soares Martins ◽

Edegmar Nunes Costa

Keyword(s):

Tendon Transfer ◽

Case Series ◽

Interference Screw ◽

Posterior Tibial Tendon ◽

Drop Foot ◽

Level Of Evidence ◽

Posterior Tibial ◽

Before And After ◽

Life Improvement ◽

Therapeutic Study

Objectives: To analyse and report the advantages of posterior tibial tendon transfer amongst patients with drop-foot as well as evaluate the degrees of foot biomechanical restoration and patient quality of life improvement. Methods: Seven patients diagnosed with drop-foot received surgery in which the posterior tibial tendon was transferred via the syndesmotic membrane, and the tendon was fixed to the lateral cuneiform bone using an interference screw. Results: The patients completed the Stanmore questionnaire before and after surgery to report their improvements with regard to all of the questionnaire criteria.Conclusion: The adopted surgical technique is an effective method of disease correction, with associated pain improvement, resumption of wearing shoes, elimination of the regular use of an ankle-foot orthosis (AFO), muscle strength gain, and functional capacity improvement. Level of Evidence IV; Therapeutic Study; Case Series.

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Tendoscopy in stage I posterior tibial tendon dysfunction

Scientific Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1155 ◽

2020 ◽

Vol 14 (1) ◽

pp. 9-13

Author(s):

Gabriel Khazen ◽

Cesar Khazen

Keyword(s):

Soft Tissues ◽

Case Series ◽

Tendon Injury ◽

Stage I ◽

Stage Ii ◽

Posterior Tibial Tendon ◽

Posterior Tibial Tendon Dysfunction ◽

Level Of Evidence ◽

Injured Area ◽

Therapeutic Study

Objective: To evaluate the progression of patients with this pathology treated by tendoscopy and with a minimum 8-year follow-up. Methods: This is a retrospective study of patients operated on between 2008 and 2011. During that period, 11 patients with this pathology aged between 28 and 56 years (average 37 years) underwent surgery. The patients were assessed subjectively using the VAS scale and the AOFAS scale was used as the objective method. Results: Nine of the 11 operated patients could be evaluated. Tendon injury was evident in three patients during the tendoscopy and open repair was indicated. Seven patients improved their symptoms according to the VAS and did not progress to stage II. Two patients progressed to stage II and underwent hindfoot reconstruction: one with tendon injury and the other without. The AOFAS scale improved on average from 64 to 96 in the patients who did not progress to stage II. Conclusion: Tendoscopic synovectomy of the PTT is an effective surgical procedure to treat patients with stage I PTTD. It has the advantages of less pain and fewer complications of the soft tissues. If a tendon injury is encountered during the tendoscopy, it must be repaired through a 3 to 4cm incision above the injured area of the tendon. Level of Evidence IV; Therapeutic Study; Case Series.

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Hemiepiphysiodesis Using a Transphyseal Screw at the Medial Malleolus for the Treatment of Ankle Valgus Deformity

Foot & Ankle Orthopaedics ◽

10.1177/24730114211061494 ◽

2021 ◽

Vol 6 (4) ◽

pp. 247301142110614

Author(s):

Rhett Macneille ◽

Joshua Chen ◽

Lee Segal ◽

William Hennrikus

Keyword(s):

Average Rate ◽

Case Series ◽

Valgus Deformity ◽

Institutional Review Board ◽

Medial Malleolus ◽

Level Of Evidence ◽

Institutional Review ◽

Average Change ◽

Ankle Valgus

Background: The purpose of this study is to report outcomes of transphyseal screw hemi-epiphysiodesis at the medial malleolus for the treatment of valgus ankle deformity. Methods: An institutional review board–approved retrospective review was done of 24 patient charts. Lateral distal tibial angle (LDTA) was measured preoperatively and at final follow-up. Results: The average change in LDTA was 8.3 degrees (SD 4.9 degrees; range 0-19 degrees). The average rate of correction was 0.4 degrees per month (SD 0.3; range 0-1.4). Conclusion: Medial malleolar transphyseal screw hemiepiphysiodesis is a simple, effective, and safe treatment for valgus ankle deformity in skeletally immature children. Level of Evidence: Level IV, case series.

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