Posterior tibial tendon rupture

Posterior Tibial Tendon Rupture

The posterior tibial tendon is a critical structure in the foot and ankle, responsible for maintaining the arch of the foot and providing stability during walking. A rupture of this tendon can lead to significant functional impairment and deformity.

Anatomy

The posterior tibial tendon originates from the posterior tibialis muscle, which is located in the deep posterior compartment of the leg. The tendon travels down the leg, behind the medial malleolus, and inserts into the navicular bone and the medial cuneiform, with extensions to the metatarsals. It plays a crucial role in foot biomechanics, particularly in supporting the medial longitudinal arch and inverting the foot.

Causes

Posterior tibial tendon rupture can occur due to:

• Trauma: Direct injury to the tendon, such as a fall or a blow to the medial side of the ankle.
• Degeneration: Chronic overuse, particularly in middle-aged women, can lead to tendinopathy and eventual rupture.
• Inflammatory conditions: Diseases such as rheumatoid arthritis can weaken the tendon.

Symptoms

Patients with a posterior tibial tendon rupture may experience:

• Pain: Along the course of the tendon, especially behind the medial malleolus.
• Swelling: Around the ankle and foot.
• Flatfoot deformity: Loss of the medial arch, leading to a flatfoot appearance.
• Weakness: Difficulty in performing activities that require foot inversion or standing on tiptoe.

Diagnosis

Diagnosis is typically made through a combination of clinical examination and imaging studies:

• Physical examination: Observation of foot posture, palpation of the tendon, and functional tests such as the "single limb heel rise" test.
• Imaging: MRI is the gold standard for visualizing tendon integrity, while ultrasound can also be used to assess the tendon.

Treatment

Treatment options depend on the severity of the rupture and the patient's functional demands:

• Conservative management: Includes rest, immobilization with a cast or brace, and physical therapy.
• Surgical intervention: May be necessary for complete ruptures or when conservative treatment fails. Surgical options include tendon repair, tendon transfer, or osteotomies to correct deformity.

Prognosis

The prognosis for posterior tibial tendon rupture varies. Early diagnosis and appropriate treatment can lead to good functional outcomes, but delayed treatment may result in persistent deformity and disability.

Also see

• Flatfoot
• Tendinopathy
• Ankle injuries
• Foot biomechanics