Acute Rupture of the Tibialis Anterior Tendon: A Case Report

Abstract

Acute rupture of tendons on the dorsum of the foot is rare and the diagnosis can be difficult. We present the case of a 51-year-old man who sustained an acute rupture of the tibialis anterior tendon. Pain about the medial aspect of the midfoot and ambulation with a steppage gait were the keys to formulating a correct diagnosis. The tendon was repaired primarily 10 days after injury. At his final follow-up examination 6 months after surgery, the patient was asymptomatic and ambulated with a normal gait.

Tendinopatia do compartimento anterior do tornozelo

“…A etiopatogenia traumática das roturas tendíneas foi a mais encontrada e, nesta série, foi devida à laceração por ferimento cortocontuso. Rimoldi et al (3) relatam casos de rotura traumática por contração isotônica súbita ou ainda estiramento tendíneo por excesso de flexão plantar. As afecções de origem atraumática contempladas nesta casuística resultaram em tendinopatia crônica pelo processo degenerativo ou inflamatório de diversas etiologias: atrito, movimentos de repetição, patologia sinovial, variação anatômica (ventre muscular alongado ou acessório), etc.…”

“…A rotina do exame de imagem incluiu inicialmente a radiografia que evidenciou edema de partes moles (2) , osteófitos marginais e outras anomalias ósseas (3) . Consideramos como padrão ouro de imagem a ressonância magnética que permite o diagnóstico, estadiamento e distanciamento dos cotos.…”

“…As roturas completas devidamente estadiadas têm no tratamento cirúrgico o méto-do de eleição na preferência dos autores (1,3,4) . Entretanto, Markarian et al (5) , Burman (1934) e Moskowitz (1971) apud Kashyap e Prince (2) relatam bons resultados com tratamento conservador de tendinopatias e afirmam que o tratamento não cruento pode ser uma boa alternativa para os pacientes idosos de baixa demanda funcional.…”

Tibialis Anterior Tendon and Extensor Retinaculum: Imaging in Cadavers and Patients with Tendon Tear

“…Being one of the strongest dorsiflexors of the ankle [10], the tibialis anterior tendon, which also assists inversion of the foot, functions during the unloaded, swing phase of walking and controls plantar flexion at initial ground contact [11]. Because of its function and the relatively straight course of the tendon and its passage through retention tunnels formed by the extensor retinaculum, minimal mechanical demands are placed on it, making the tendon less subject to wear than other tendons of the foot and ankle [10].…”

“…They can generally be divided into two categories: first, acute rupture secondary to laceration, a sudden violent force, and fractures [8,12]; and, second, acute-on-chronic or spontaneous rupture [13,14]. Spontaneous ruptures are less frequent, and most occur through its mid substance, which is the central portion of the tendon along its short axis [6,11]. For such ruptures to occur, there must be pathophysiologic changes within the tendon causing structural weakness.…”