Postoperative results of distal tibialis anterior tendinosis

Lemmens, Laura; Beek, Nathalie van; Verfaillie, Stefaan

doi:10.1016/j.fas.2019.11.005

Cited by 4 publications

(13 citation statements)

References 11 publications

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“…Indeed, a PubMed search identified 5 publications on DTAT since those I have mentioned. 2,3,5,6,11 Thus, it would appear that a limited literature review has been undertaken by Levitsky et al, 7 which in my view detracts from the merit of this otherwise interesting article.…”

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confidence: 87%

Letter Regarding: Risk Factors for Anterior Tibial Tendon Pathology

Beischer¹

2021

Foot Ankle Int.

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with interest the article "Risk Factors for Anterior Tibial Tendon (ATT) Pathology" by Levitsky et al. 7 This article reported on the 2 clinical presentations of ATT pathology in a series of 94 patients. The first entity, ATT rupture, is a condition that was reported as early as 1947 by Moberg, 9 and more than 70 case reports and series have been documented in the literature ever since, with the largest series of 19 ruptures in 18 patients reported by Sammarco et al. 10 In this series, males represented a small majority (58%) of cases, whereas in the series of 15 ruptures reported by Levitsky et al, 7 62% were in women. Thus, it would appear that for ruptures of the ATT, sex probably is not a risk factor.The entity of distal tibialis anterior tendinopathy (DTAT) without rupture was first described in the radiological literature by Mengiardi et al 8 in 2005 and the clinical features by Beischer et al 1 in 2009, who reported on a series of 29 patients (33 feet) in this journal. They reported that this clinical entity was predominantly seen in women (93% of cases), with the majority being overweight or obese. They described the Tibialis Anterior Passive Stretch (TAPS) test, which can be useful in diagnosing the condition. The operative management of DTAT was reported by our group in 2010 again in this journal. 4 Our results would support the statement that most patients with DTAT can be successfully managed with nonoperative therapy, although we have found a custom accommodative insole effective in the majority. We have found that some with night pain as a major symptom can find relief by wearing a rigid ankle foot orthosis while sleeping.In the cohort of 79 patients with DTAT reported by Levitsky et al, 7 81% were women, and an average body mass index of 27.2 kg/m 2 was reported for the entire cohort. Thus, their findings support those reported initially by our group, although this was not acknowledged by Levitsky et al. 7 Although the majority (64/79) of their patient cohort displayed features of DTAT, there was no reference to this entity in their bibliography, with all references being to the rupture of the ATT. Indeed, a PubMed search identified 5 publications on DTAT since those I have mentioned. 2,3,5,6,11 Thus, it would appear that a limited literature review has been undertaken by Levitsky et al, 7 which in my view detracts from the merit of this otherwise interesting article.

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confidence: 87%

Letter Regarding: Risk Factors for Anterior Tibial Tendon Pathology

Beischer¹

2021

Foot Ankle Int.

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“…3,5,7,10,14,17,18,22 The Tibialis Anterior Passive Stretch (TAPS) test is a useful diagnostic tool during clinical examination with a reported sensitivity and specificity of 90% and 95%, respectively. 3,18,27 Imaging techniques such as ultrasonographic and magnetic resonance can be used to confirm a clinically suspected tendinopathy. 3,7,10,11,15,18,22 The majority of cases can be managed nonoperatively, although little consensus exists on which treatment protocol is most effective.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,8,12,20,21 Patients who failed conservative therapy may ultimately be treated surgically, and different techniques with good patient satisfaction have been described. 5,7,9,10,13,15,18,26 Although surgical intervention remains an option after failed conservative management, literature and common clinical practice recommend that nonoperative treatment should always be the first choice. Nonetheless, retrospective studies have reported varying results following nonoperative management, ranging from ca.…”

Section: Introductionmentioning

confidence: 99%

“…11,[17][18][19] Nonoperative strategies range from minimal adaptive measures such as insoles with medial arch support and rehabilitation, to temporary immobilization in a cast or constraint ankle movement (CAM) orthosis and corticosteroid infiltrations. 7,10,11,14,15,18,19 Corticoinfiltrations have become infamous for weakening tendon tissue by inhibiting collagen synthesis and disrupting natural healing processes, risking tendon degeneration or eventually rupture after repeated injections. 6,23 Lately, orthobiologics-such as platelet-rich plasma (PRP)-are becoming a popular alternative to corticosteroid injections in treating tendinopathies.…”

Section: Introductionmentioning

confidence: 99%

“…Despite its important function during ankle motion and ambulation, pathology of the distal TA tendon seems to remain underdiagnosed. 3,5,18 Beischer et al 3 first described the clinical presentation of distal tibialis anterior tendinopathy in a case series of 29 patients, thereby establishing it as a distinct pathology and not as the prodrome to (spontaneous) rupture. Other authors confirmed the typical presence of a burning, medial-sided midfoot pain that worsens at night and soft tissue swelling around the TA insertion with no significant loss of dorsiflexion force.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Platelet-Rich Plasma Infiltration and Weightbearing Cast Immobilization in Distal Tibialis Anterior Tendinopathy: A Prospective Cohort Study

Desomer,

van Beek,

Van Riet

et al. 2023

Foot Ankle Int.

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Background: Distal tibialis anterior tendinopathy (DTAT) is a chronic condition that may lead to functional impairment and secondary forefoot deformities when left untreated. Current clinical practice is mainly guided by case reports and small retrospective case series; little consensus exists on which treatment protocol is most effective. This study aims to assess a conservative treatment for DTAT consisting of PRP infiltration and walking cast immobilization. Methods: This prospective study included 18 feet in 18 patients, recruited between September 2020 and September 2022 at a single institution. Ultrasonography was performed; leukocyte-poor PRP was infiltrated around the tibialis anterior tendon insertion. Walking cast immobilization was used for 3 weeks after infiltration, followed by eccentric exercises of the DTAT, and gastrocnemius-soleus muscle complex stretching. Clinical findings, visual analog scale (VAS), Foot Function Index (FFI), and American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scores were recorded at inclusion, and 6 and 12 weeks after PRP infiltration. Minimal clinically important difference (MCID) limits were researched to assess clinical relevance of statistical outcomes. Means were determined for age, sex, and body mass index (BMI). One-way repeated measures ANOVA was performed over time for FFI, AOFAS, and VAS scores. Results: Mean age was 65 years with a mean BMI of 25. Tendon thickening and hypoechogenicity were the most commonly reported ultrasonographic findings. Significant improvement from baseline VAS (VASrest: 4.71 ± 2.7, VASactivity: 5.66 ± 2.5) to 12 weeks follow-up (VASrest: 2.14 ± 2.7, VASactivity: 3.34 ± 2.5) was found. Both AOFAS and FFITotal improved significantly from baseline (AOFAS: 66.9 ± 3.3, FFITotal: 32.9 ± 3.3) to 6-week follow-up (AOFAS6w: 79.4 ± 3.3, P = .019; FFITotal: 19.4 ± 3.3, P = .011). No statistically significant further improvement was found at 12 weeks compared to 6 weeks’ follow-up. Two (11%) patients chose operative treatment because of persisting symptoms. Conclusion: We found that PRP infiltration with walking cast immobilization as a first-line treatment was associated with general early symptom improvement. Level of Evidence: Level IV, case series.

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