Recurrent dislocation of tibialis posterior tendon

Abstract

We successfully treated two patients with recurrent dislocation of the tibialis posterior tendon by creating a bone block. Sudden resistive contraction of the tibialis posterior muscle is considered to be the mechanical cause of the initial traumatic injury, and a shallow tibialis posterior tendon sulcus may be the predisposing factor. Once the flexor retinaculum is torn during the initial trauma, recurrent dislocation is inevitable, and surgical treatment is mandatory. When treating patients with a complaint of long-standing pain around the medial malleolus, we must bear in mind the possible diagnosis of recurrent dislocation of the tibialis posterior tendon. If the patient can voluntarily dislocate the tendon by active plantar flexion and inversion of the ankle, the diagnosis is definitive.

Unilateral Dislocation of the Posterior Tibialis Tendon (PTT) and Flexor Digitorum Longus Tendon With Contralateral PTT Subluxation in a Patient With Congenitally Shallow Flexor Groove

“…1,3,7,9 Some patients can volitionally dislocate their tendons and reproduce pain; others have been noted to have a PTT located anterior to the medial malleolus. 1,10 Diagnosis of this pathology can be difficult and physical examination findings in addition to advanced imaging (magnetic resonance imaging [MRI]) are crucial in assessment. Plain radiographs are often negative, but may infrequently reveal a small avulsion fracture at the insertion of the flexor retinaculum on the medial malleolus.…”

“…3,5,9,12 Treatment algorithms for a dislocated PTT have ranged from nonoperative management to formal groove deepening and retinacular repair or imbrication. 1,7,10,13,14 However, to date, no case has been described of unilateral traumatic dislocation of both the PTT and flexor digitorum longus (FDL) tendon with contralateral subluxation of the other PTT.…”

“…1,3,7,9 Some patients can volitionally dislocate their tendons and reproduce pain; others have been noted to have a PTT located anterior to the medial malleolus. 1,10…”

Posterior tibial tendon dislocation: a systematic review of the literature and presentation of a case

“…The mechanism leading to a posterior tibial tendon dislocation may typically be a twisting of the foot, but sometimes pronation–external rotation injuries29 30 and even spontaneous occurrence11 25 28 29 35 36 are documented. A shallow retromalleolar groove is considered to be a predisposing feature in about half of the patients 3.…”

Diagnosis and Management of the Painful Ankle/Foot Part 1: Clinical Anatomy and Pathomechanics

“…The tibialis posterior tendon and tenosynovium are exposed to excessively high tensile forces during the landing sequence, leading to overuse tensosynovitis, 138 traumatic dislocations, 139 and partial or complete ruptures 140 . Complete ruptures, although very rare, emerge as a sequel to macrotrauma and can subject the subtalar and midtarsal system to significant mechanical alteration 141 .…”