Traumatic Dislocation of Tibialis Posterior Tendon: A Case Report and Literature Review

Abstract

Traumatic dislocation of the tibialis posterior tendon is one of the significantly rare conditions that we might deal with in the emergency department. Approximately only 50 cases have been reported in the literature, and, usually, this condition is misdiagnosed as an ankle sprain in acute settings. It might be neglected in case of improper clinical examination and imaging techniques. We present a case of a 39-year-old patient diagnosed with traumatic dislocation of the tibialis posterior tendon as a result of twisting injury after falling from a 1-meter jump height while playing basketball; the patient was clinically diagnosed primarily as a case of simple ankle sprain in the emergency department and treated conservatively with cold compression. The patient was seen in the clinic after five days with the same complaint, which was medial ankle pain without any improvement. Proper examination and imaging techniques lead us to the accurate diagnoses. The patient was managed surgically and had an excellent outcome postoperatively with a full range of motion of the ankle joint and full weight-bearing without any complaint. Tibialis posterior dislocation should be one of the possible differential diagnoses while dealing with any ankle injury even with unremarkable X-rays. History and physical examination, if conducted correctly, are the keys to making an accurate diagnosis. Therefore, we recommend a proper history-taking and precise physical examination with a high index of suspicion for any possible diagnoses. Early surgical intervention for such cases is the preferable method of treatment to avoid further complications and promote early functional recovery.

Lower leg muscle recovery takes at least 12 months for functional tests to recover after late reconstruction of the tibialis posterior tendon retinaculum

“…Most case reports involve short descriptions of the rehabilitation programmes, which commonly involve range-of-motion exercises and jogging 1–7 10 11 17…”

“…Traumatic dislocation of the tibialis posterior tendon is an extremely rare injury, with approximately 50 reported cases in the English literature 1–7. The first case was reported by Martius after falling from a balloon in 1874 8.…”

“…Rehabilitation protocols include the use of an orthotic boot or cast immobilisation, followed by progressive weight bearing with restoration of ankle motion. A return to pivoting activities is not recommended before 6 months 2. Case reports have reported successful treatment of patients from 61 up to 2813 months postoperatively.…”

Rupture of posterior tibial tendon in a bimalleolar ankle fracture: A case report

“…The tendon dysfunction can lead to acquired flatfoot deformity in adults. It lies immediately posterior to the medial malleolus passing through a fibro-osseous tunnel where it changes direction acutely, like a bowstring [1] . The complete rupture of the posterior tibial tendon (PTT) associated with ankle fractures is a rare frequently overlooked condition that can cause long-term patient disability if not properly treated [2] .…”

Reconstruction of the Tibialis Posterior Flexor Retinaculum: Description of Surgical Technique

“…Acute dislocation of the tibialis posterior tendon is a rare injury that is poorly characterized in Western literature. These injuries often have a delayed diagnosis due to their rarity and treating clinicians' unfamiliarity with their presentation and can be misdiagnosed as a sprain in certain settings [1]. The tibialis posterior plays a significant role in plantar flexion and inversion of the foot.…”