Tibialis posterior tendon rupture

Case
A 53 year old coach presented after an injury sustained falling down two stairs three months previously. He described experiencing a popping sensation followed by well localised pain around the medial side of his foot and ankle. On examination there was localised tenderness about the medial malleolus and navicular tuberosity, pain and weakness with resisted ankle inversion and an inability to perform single leg calf raises. His foot posture appeared grossly normal however his heel did not move into varus when performing a calf raise.

Findings
An x-ray series of the foot is within normal limits, with no significant loss of the medial arch and normal foot architecture. MRI sequences define a full-thickness tear of the tibialis posterior tendon 2.5 cm proximal to the navicular. The proximal tendon stump is retracted behind the medial malleolus, above the level of the ankle mortise. There is a 5 cm gap between the tendon ends. The proximal stump is thickened, measuring 12 x 10 mm. The entire tibialis posterior muscle has oedema with a fibrillary pattern.

Discussion
After diagnosis this patient was seen by a sub-specialist foot and ankle surgeon. The tendon was not felt to be repairable based on the nature of the tendon, the location of the rupture and the delay from the injury. He underwent a flexor digitorum longus (FDL) tendon transfer with a calcaneal osteotomy. He is currently rehabilitating following surgery.

There is often a considerable delay in the diagnosis of this injury, with one case series highlighting an average time to treatment of 43 months. As a result a high level of suspicion is needed. The injury is generally associated with an eversion injury mechanism. Common presenting symptoms include pain along the course of the tendon, weakness of ankle inversion and a loss of the medial longitudinal arch. Patients generally find calf raises difficult, lack heel varus with calf raises and may display the “too many toes” sign (the appearance of more toes on the affected side when viewed from behind). Younger patients generally sustain an avulsion injury from the insertion into the navicular, while middle aged or elderly individuals general suffer a mid-substance tear (as seen here). In the acute phase x-rays are generally not helpful, with ultrasound or MRI being the most useful imaging modalities. Surgical treatment is usually required. Soft tissue procedures, including primary repair, are effective when the diagnosis is made promptly. In this case that was not possible. A tendon transfer is a good option however the FDL tendon is not as strong as the tibialis posterior and will weaken over time under that amount of load. As a result, further measures are needed to adjust the mechanics of the hindfoot. In this case a medial displacement calcaneal osteotomy, which reduces the lever arm on the tendon, was completed to try to ensure good long term function.

Important notice
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Adel Ghazi (Moh'd Khair) El-Kailani
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Adel Ghazi (Moh'd Khair) El-Kailani

Ll

Mustafa yusuf
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Thank you

Mohammad
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Mohammad

Very nice fracures x ray insignificant for bone we can use also cts in some cases in fracture intra articular surface like knee hip ankel joints MRI in any injuries not significantly by x ray espcially sprain ligamintus injury partial and complete tear very nice case also need good physical examinations after that we decide what we do but first we should do xray routine to detect fracture or not thanx.

Ahmed Eid Awad Allah Ismail
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Ahmed Eid Awad Allah Ismail

شكراً

ZVASIYA
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ZVASIYA

Thank you

Gerges Emeel Nasseif
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Gerges Emeel Nasseif

many thanks

fuhaim
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fuhaim

`too many toes sign’ is a new thing ,thanks

NASSER KHALFAN ABDULLAH AL HOUMANI
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NASSER KHALFAN ABDULLAH AL HOUMANI

بصراحة دورة مفيدة ومتكاملة تضم مجموعة من المعلومات المفيدة

NASSER KHALFAN ABDULLAH AL HOUMANI
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NASSER KHALFAN ABDULLAH AL HOUMANI

ما ممكن انزل محتوى الدورة من أجل الاحتفاظ به على جهازي الخاص

Hesham.A.Brekaw
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Hesham.A.Brekaw

As a good first step

Amir
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Amir

Thank you

HASAN MUHAMMAD DAHIR
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HASAN MUHAMMAD DAHIR

معلومات قيمة بارك الله بكم شكراً لكم

MOHAMMED KHAMIS JUMA ALGHASSANI
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MOHAMMED KHAMIS JUMA ALGHASSANI

مرحبًا
كيف اقدر احوله عربي

Ahmed Aly Hassan
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Ahmed Aly Hassan

google translate

Welwel
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Welwel

نريده باللغة العربية

Dr.naglaa Muhammad Ibrahim
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Dr.naglaa Muhammad Ibrahim

فعل جوجل ترانسليت علي التليفون او ع اللاب من اعدادات الصفحة

Dr.naglaa Muhammad Ibrahim
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Dr.naglaa Muhammad Ibrahim

يمكنك ارسال دعوة لي ونتواصل للمساعدة

Yahya
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Yahya

Guys,,I need fellowship somewhere ,,someone kindly guide.. thanks

Dr.naglaa Muhammad Ibrahim
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Dr.naglaa Muhammad Ibrahim

يمكنك إضافتي ونتواصل للمساعدة

HD
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HD

Oky

Bangoura
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Bangoura

TOUT TRAUMATISME DE LA CHEVILL ET DU PIED DOIT ETRE PRIS AU SERIEUX QU IL SOIT SEDENTAIRE OU SPORTIF..
PROCEDER A UNE TRES BONNE CONSULTATION
DEMANDER DES EXAMENS COMPLEMENTAIRES
1-UNE RADIOGRAPHIE NUMRRISEE SUR PLUSIEURS INCIDENCES
RENFORCER PAR L IRM PUIS LE SCANER SI NECESSAIRE.
EN CAS DE CONFIRMATION D UNE RUPTURE DU TENDON POSTERIEUR TIBIAL UNE INTERVENTION CHIRURGICALE S IMPOSE POUR UNE MEILLEURE PRISE EN CHARGE
DES SEANCES PHYSIOTHERAPIE
DE MASSAGE
DE KINESITHERAPIE
LA REEDUCATION DOIT ETRE PROGRESSIVES
LA REPRISE DES ACTICITES DEPEND DE L EVOLUTION ET DE LA COMPLEXITE DE L INTERVENTION.

bassam gwhrh
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bassam gwhrh

يجب علينا القيام بروتين الأشعة السينية للكشف عن الكسر أو لا ثناكس

Hamda
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Hamda

Very good

Hamda
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Hamda

Very good

Ehab
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Ehab

شكرا لكم على المعلومات القيمة

Dr. Emad khlaif jaber
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Dr. Emad khlaif jaber

Thank you

SAID MOHAMD SALIMAN
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SAID MOHAMD SALIMAN

A useful and valuable article

SAID MOHAMD SALIMAN
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SAID MOHAMD SALIMAN

Thank you so much

Sachin kumar
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Sachin kumar

An useful and informative article.
Tendon transfer is the good option in this kind of injury but after that we’ll have to focus on the foot biomechanics nd proper rehabilitation.

Rodrigo Peixoto dos Santos
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Rodrigo Peixoto dos Santos

Very complex case of clinical diagnosis, but the image seemed to close the case with clarity! Great

Ayham alshoufeen
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Ayham alshoufeen

Nice

Jamaleddine almouhandiz
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Jamaleddine almouhandiz

شكرا جزيلا