Acute Rupture of the Tibialis Posterior Tendon without Fracture

Martinelli, Nicolò; Bonifacini, Carlo; Bianchi, Alberto; Moneghini, Laura; Scotto, Gennaro; Sartorelli, Elena

doi:10.7547/0003-0538-104.3.298

Cited by 9 publications

(8 citation statements)

References 15 publications

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“…The clinical evaluation in this setting should include an appropriate medical history taking (signs of TPT dysfunction) with plain radiographic examination. Clinical evaluation alone may not be sufficient in diagnosing acute TPT rupture and magnetic resonance imaging might be helpful in the immediate management of TPT rupture for early surgical repair [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…The pathogenic mechanism leading to the rupture of an apparently healthy tendon is generally a trauma in pronation and external rotation and, less frequently, a direct trauma to the ankle. Signs and symptoms of a TP insufficiency, like swelling and pain along the course of the tendon with or without a progressive loss of the medial arch, swelling in the region of the medial malleolus indicate in some cases a TP rupture [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Surgical Repair of Traumatic Rupture of Tibialis Posterior Tendon in 32-Year-Old Male

Agrawal¹,

Ghodke²,

Issrani³

et al. 2022

JOCR

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Introduction: This article reports a case of surgical repair of traumatic rupture of tibialis posterior (TP) tendon in a young healthy male after alleged history of grinder (heavy machine) injury over the foot, with the help of a suture anchor and running whip stitch followed by immobilization in a below knee slab postoperatively. The acute rupture of the TP tendon (TPT), 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. Case Report: A 32-year-old healthy male presented to the outpatient clinic with a history of pain and swelling in the right foot for 10 months after alleged history of sustaining a grinder (heavy machine) injury to the medial aspect of the right foot 10 months ago. Anteroposterior and oblique radiographs of the right foot suggestive of no skeletal pathology and patient was managed conservatively with analgesic, anti-inflammatory, and compression bandaging. A magnetic resource imaging of the right foot was advised after no relief of symptoms and was suggestive of high-grade tear of the distal tibialis posterior tendon from the level of medial malleolus to its insertion. Surgical repair of the TPT was planned with a suture anchor placed in the navicular bone. The procedure was carried out under spinal anesthesia and there were no complications in the intraoperative or post-operative period. Patient was given a below knee slab with the foot in inversion postoperatively which was revised into a below knee cast with foot in inversion. Six-week post-operative follow-up, cast was removed and physiotherapy was started for the patient that included Active Ankle ROM and Gait Training, patient had a Modified Olerud and Molander Score of 45/100. Six-month post-operative follow-up, patient was relieved of chronic pain and was able walk and stand on his toes without pain and showed significant improvement in gait with Modified Olerud and Molander Score 90/100. Conclusion: The TPT is the main dynamic stabilizer of the medial longitudinal arch of the foot. With appropriate surgical technique, adequate post-operative immobilization followed by physiotherapy surgical repair of the TPT helped alleviate the chronic pain experienced by the patient during weight bearing activities.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical Repair of Traumatic Rupture of Tibialis Posterior Tendon in 32-Year-Old Male

Agrawal¹,

Ghodke²,

Issrani³

et al. 2022

JOCR

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“…9 Spontaneous rupture of a healthy tendon is rare, whereas it may occur in the context of chronic tendinopathy, rheumatoid arthritis and non-specific tenosynovitis. 2,11,12 The most common pathology that affects the PTT is chronic tendinopathy 13 and the progressive "chewing gum" lesion in a setting of chronic tendinopathy, 1,9 which occurs mostly in overweight women above 50 years of age who have valgus flat foot. 14 Comorbidities such as aging, diabetes, corticosteroid therapy, obesity, rheumatoid arthritis, connective tissue disease and hypertension can be risk factors for rupture and long-term insufficiency.…”

Section: Discussionmentioning

confidence: 99%

“…18 In the literature, we found only limited articles that reported complete posterior tibialis rupture associated with a closed ankle fracture. [1][2][3]5,7,8,11,12,16,18,[20][21][22][23][26][27][28][29][30][31][32][33][34][35] Giblin et al 31 first described the PTT rupture associated with a closed medial malleolar fracture in 1980. Most of the articles reported complete rupture of the PTT with medial malleolus involvement.…”

Section: Discussionmentioning

confidence: 99%

Posterior tibialis tendon rupture concomitant with a closed medial malleolar fracture: A case report and literature review

Talebi¹,

Sheibani²,

Ghaffari³

et al. 2021

Journal of Orthopaedics, Trauma and Rehabilitation

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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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“…When the radiographic pattern of the injury does not prompt a medial incision, the diagnosis is more challenging. Persistent pain, inability to invert the foot, and rapidly progressive flat foot after injury 19 may alert an astute clinician to a potential tibialis posterior injury. Although the authors do not advocate routine use of these modalities, ultrasound or magnetic resonance imaging can be used to evaluate the integrity of the tibialis posterior tendon in highly suspicious cases.…”

Section: Discussionmentioning

confidence: 99%

Acute Tibialis Posterior Tendon Rupture With Pronation-Type Ankle Fractures

Bernstein¹,

Harris²,

Cosculluela³

et al. 2016

Orthopedics

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Tibialis posterior tendon rupture in the setting of pronation-type ankle fractures can lead to long-term debility as a result of chronic tendon dysfunction. This rare injury pattern presents a diagnostic challenge because thorough preoperative examination of the function of the tendon is limited by pain, swelling, and inherent instability of the fracture. As such, a high index of suspicion is necessary in ankle fractures with radiographs showing a medial malleolus fracture with an associated suprasyndesmotic fibula fracture. This report describes 3 cases of tibialis posterior tendon rupture associated with pronation-type ankle fractures treated acutely with open reduction and internal fixation and primary tendon repair. Additionally, common features of this injury pattern are discussed based on the current literature. In accordance with this report, the typical mechanism of injury is high energy and includes forced pronation, external rotation, and dorsiflexion of the ankle, which places maximal stress on the tibialis posterior tendon. Rupture most commonly occurs in a relatively hypovascular area of the tendon located at the posteromedial extent of the medial malleolus fracture. In the operative treatment of pronation-type ankle fractures, direct inspection of the tibialis posterior tendon allows for timely diagnosis and treatment of associated ruptures. [Orthopedics.2016; 39(5):e970-e975.].

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Acute Rupture of the Tibialis Posterior Tendon without Fracture

Cited by 9 publications

References 15 publications

Surgical Repair of Traumatic Rupture of Tibialis Posterior Tendon in 32-Year-Old Male

Surgical Repair of Traumatic Rupture of Tibialis Posterior Tendon in 32-Year-Old Male

Posterior tibialis tendon rupture concomitant with a closed medial malleolar fracture: A case report and literature review

Acute Tibialis Posterior Tendon Rupture With Pronation-Type Ankle Fractures

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