Longitudinal Tears of Both Peroneal Tendons Associated With Tophaceous Gouty Infiltration. A Case Report

Lagoutaris, Emmanuel D; Adams, Heiko B.; DiDomenico, Lawrence A.; Rothenberg, Ralph J.

doi:10.1053/j.jfas.2005.02.008

Cited by 47 publications

(24 citation statements)

References 7 publications

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“…The impact of tendon MSU crystal deposition on musculoskeletal function is currently uncertain. Tendon rupture due to tophus infiltration has been described in patients with chronic gout, although this would appear to be an uncommon event 3 9 10. Many parameters of gait are impaired in patients with chronic gout even in the absence of a flare 11.…”

Section: Discussionmentioning

confidence: 99%

Tendon involvement in the feet of patients with gout: a dual-energy CT study

et al. 2013

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Section: Discussionmentioning

confidence: 99%

Tendon involvement in the feet of patients with gout: a dual-energy CT study

et al. 2013

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“…It was believed that gouty tophi did not lead to tendon destruction, one important difference from pannus. However, after cases reported in the literature that show tendon ruptures and surgical findings of a thick, chalky-white substance consistent with gouty tophus, embedded within tendons [4], and tendon ruptures where massive white crystals were deposited intratendinously and paratendinously [5], it is now accepted that gouty tophi may play a role in tendon destruction.…”

Section: Introductionmentioning

confidence: 99%

Sonographic description and classification of tendinous involvement in relation to tophi in chronic tophaceous gout

et al. 2010

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ObjectiveTo describe and classify the varied ultrasound features of tendinous involvement in relation to tophi in chronic tophaceous gout so that they are better recognised.MethodsUltrasound images of 138 affected areas from 31 patients with chronic tophaceous gout were analysed using high-quality broadband linear transducers. The relationship between tendon and tophi was classified, and the inter-observer agreement regarding classification was analysed.ResultsTophi envelopment in the tendon was the most frequent characteristic (45%) followed by no relationship between tophi and tendon (41%), tophi at the insertion site of the tendon (7%), extrinsic compression (6%) and tophi within the tendon (1%). The inter-observer concordance on classification of the relationship between tophi and tendon was measured using McNemar’s test with P < 0.001 (χ2 = 30.0, degree of freedom = 9) and kappa test = 0.627 (P < 0.001), indicating substantial inter-observer concordance.ConclusionTophi generally envelope the tendon or there is no relationship between them. Tophi can also be found at the insertion site of the tendon, cause extrinsic compression or be located inside the tendon. There is substantial inter-observer agreement for ultrasound classification of tendon involvement by tophi. This study contributes to diagnostic elucidation and shows the diverse characteristic forms of tendon involvement by tophi.

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“…Eversion and inversion motions of the foot, which involve the peroneal and tibialis posterior muscles, are also important throughout the gait cycle, particularly for their contribution to shock absorption and stability [21]. Although the impact that MSU deposition in these ankle structures has on muscle strength remains unclear, several case studies investigating tendon ruptures of the ankle and foot in the gout populations have suggested that the presence of tophi reduces the tensile capacity of tendons [22][23][24]. Furthermore, the infiltration of tophi into muscle tissues may potentially reduce the functional cross-sectional muscle area (i.e.…”

Section: Discussionmentioning

confidence: 99%

Foot and ankle muscle strength in people with gout: A two-arm cross-sectional study

Stewart

Mawston

Davidtz

et al. 2016

Clinical Biomechanics

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Foot and ankle muscle strength in people with gout: a two-arm cross-sectional study, Clinical Biomechanics (2015Biomechanics ( ), doi: 10.1016Biomechanics ( /j.clinbiomech.2015 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT ABSTRACTBackground Foot and ankle structures are the most commonly affected in people with gout.However, the effect of gout on foot and ankle muscle strength is not well understood. The primary aim of this study was to determine whether differences exist in foot and ankle muscle strength for ankle plantarflexion, dorsiflexion, inversion and eversion between people with gout and age-and sex-matched controls. The secondary aim was to determine whether foot and ankle muscle strength was correlated with foot pain and disability.Methods Peak isokinetic concentric muscle torque was measured for ankle plantarflexion, dorsiflexion, eversion and inversion in 20 participants with gout and 20 matched controls at two testing velocities (30°/s and 120°/s) using a Biodex dynamometer. Foot pain and disability was measured using the Manchester Foot Pain and Disability Index (MFPDI).Findings Participants with gout demonstrated reduced muscle strength at both the 30°/s and 120°/s testing velocities for plantarflexion, inversion and eversion (p<0.05). People with gout also displayed a reduced plantarflexion-to-dorsiflexion strength ratio at both 30 o /s and 120 o /s (p<0.05). Foot pain and disability was higher in people with gout (p<0.0001) and MFPDI scores were inversely correlated with plantarflexion and inversion muscle strength at the 30°/s testing velocity, and plantarflexion, inversion and eversion muscle strength at the 120°/s testing velocity (all p<0.05).Interpretation People with gout have reduced foot and ankle muscle strength and experience greater foot pain and disability compared to controls. Foot and ankle strength reductions are strongly associated with increased foot pain and disability in people with gout.

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Longitudinal Tears of Both Peroneal Tendons Associated With Tophaceous Gouty Infiltration. A Case Report

Cited by 47 publications

References 7 publications

Tendon involvement in the feet of patients with gout: a dual-energy CT study

Tendon involvement in the feet of patients with gout: a dual-energy CT study

Sonographic description and classification of tendinous involvement in relation to tophi in chronic tophaceous gout

Foot and ankle muscle strength in people with gout: A two-arm cross-sectional study

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