#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Tibialis posterior tendon rupture in patients with rheumatoid arthritits


Authors: S. Popelka;  P. Vavřík;  R. Hromádka;  V. Barták;  A. Sosna
Authors‘ workplace: 1. ortopedická klinika 1. LF UK, FN Motol
Published in: Čes. Revmatol., 18, 2010, No. 4, p. 176-180.
Category: Original Papers

Overview

Aim:
The aim of this work is to point out the significance of tibialis posterior tendon insertion on the function of the foot. Tibialis posterior tendon is a significant forefoot stabilizer. Dysfunction of this tendon leads to foot instability in the talonavicular and calcaneocuboid joints, lowering of the longitudinal arch, and causing valgus heel deformity.

Patients and methods:
From 2000 to 2009, we treated 11 patients with the signs of tibialis posterior tendon rupture. Prior to surgery, the patients were examined by MRI of the foot focusing on tibialis posterior tendon. During the surgery, the tibialis posterior tendon was repaired. In 9 cases, we found a complete tibialis posterior tendon rupture, and in 2 cases, the tendon was markedly thin and destructed by rheumatologic process. In these cases, we chose to perform anisolated talonavicular arthrodesis. In one female patient, rupture of tibialis posterior tendon was detected soon enough to enable its transosseal suture into naviculare bone.

Results:
From 2002 to 2008, we performed surgery in 11 patients (10 females and 1 male). The average age at the time of surgery was 46.9 years. Subjective ailment of each patient was evaluated. The surgery was perceived positively by almost all patients. Ten patients reported virtually no symptoms, whereas one patient still suffers from mild pain in the dorsum of the foot. Kitaoka Hindfoot score was 49.6 before and 89.6 after the operation. As to the complications of this procedure, one female patient suffered from superficial inflammation in the surgical wound. The arthrodesis healed uneventfully in all patients except one female patient, who experienced a prolonged healing of arthrodesis.

Conclusion:
Early recognition and surgical treatment ensures stability of the foot and prevents its deformity, which would require a major surgical intervention.

Key words:
rheumatoid arthritis, m. tibialis posterior, deformity of the foot, pes planovalgus


Sources

1. Cracchiolo A. Rheumatoid Arthritis. Clin Orthop 1997; 340: 58-68.

2. Popelka S, Vavřík P. Chirurgická léčba deformit nohy a hlezna u pacientů s revmatoidní artritidou. Čes Revmatol 2003; 11: 20-25.

3. Popelka S, Vavřík P. Revmatochirurgie nohy a hlezna. StudiaGeo, Praha, 2005.

4. Fernandes R, Aguiar R, Trudell D, Resnick D. Tendons in the planta aspect of the foot: MR imaging and anatomic correlation in cadavers. Skeletal radiology 2007; 36: 115-122.

5. Pastore D, Dirim B, Wangwinyuvirat M, Belentani CL, Haghighi P, Trudell DJ, Cerri GG, Resnick DL. Complex distal insertions of the tibialis posterior tendon: detailed anatomic and MR imaging investigation in cadavers. Skeletal radiology 2008; 37: 849-855.

6. Johnson KA. Tibialis posterior tendon rupture. Clinical Orthop 1983; 17: 140-147.

7. Mann RA, Thompson FM. Rupture of the posterior tibial tendon causing flat foot. Surgical treatment. J Bone Joint Surg 1985; 67-A: 556-561.

8. Hintermann B. Tibialis posterior dysfunction: a review of the problem and personal experience. Foot and Ankle Surgery 1997; 3: 61-70.

9. Funk DA, Cass JR, Johnson KA. Acquired adult flat foot secondary to posterior tibial-tendon patology. J Bone Joint Surg 1986; 68-A: 95-102.

10. Kulik K, Pomrantz AB, Burnfield JM, Reischl SF, Mais-Requejo S, Thordarson BD, Smith RW. Non-operative management of posterior tibialis tendon dysfunction: design of a randomized clinical trial. BMC Musculoskeletal Disorders 2006; 7: 49.

11. Flemister AS, Seville CG, Houck J. The relationship between Ankle, hindfoot and forefoot position and posterior tibial musle excursion. Foot Antle Int 2007; 28: 448-455.

12. Hromádka R, Barták V, Popelka S, Jahoda D, Pokorný D, Sosna A. Bloková anestezie nohy provedená ze dvou kožních vpichů (anatomická studie). Acta chir Orthop Traum čech 2009; 76: 104-109.

13. Hromádka R, Barták V, Popelka S, Pokorný D, Jahoda D, Sosna A. Ankle Block Implemented Through Two Skin Punctures. Foot and Ankle International 2010; 31: 619-623.

14. Kitaoka HB, Alexander IL, Adelaar RS, Nunley JA, Myerson MS. Clinical Raiting Systems for the Ankle, Hindfoot, Midfoot, Hallux and Lesser Toe. Foot Ankle Int 1994; 15: 349-353.

15. Elboar JE, Thomas WH, Weinfeld MS, Potter TA. Talonavicular Arthrodesis for Rheumatoid Arthritis of the Hindfoot. Orthop Clin of North America 1976; 7: 821-826.

16. Miehlke W, Gschwend N, Rippstein P, Simmen BR. Compression Arthrodesis of the Rheumatoid Ankle and Hindfoot. Clin Orthop 1997; 340: 75-86.

17. Popelka S, Vavřík P, Hromádka R, Sosna A. Lapidus procedure in Patients with Rheumatoid Arthritis – Short-Term Results. Z Orthop Unfall 2008; 146: 80-85.

18. Popelka S, Vavřík P, Hromádka R, Sosna A. Naše zkušenosti s operací podle Lapiduse u pacientů s hallux valgus. Acta chir Orthop Traum čech 2008; 75: 271-276.

19. Frey C, Shereff M, Greenidge N. Vascularity of the posterior tibial tendon. J Bone Joint Surg 1990; 72-A: 884-888.

20. Kindsfater K, Wilson MG, Thomas WH. Management of the Rheumatoid Hindfoot With Special Reference to Talonavicular Arthrodesis. Clin Orthop 1997; 340: 69-74.

21. Miyamoto N, Senda M, Hamada M, Katayama Y, Kinosita A, Uchida K, Inoue H. Talonavicular Joint Abnormalities and Walking Ability of Patiens with Rheumatoid Arthritis. Acta Medica Okayama 2004; 58: 85-90.

22. Rammelt S, Marti RK, Zwipp H. Arthrodesis of talonavicular joint. Orthopäde 2006; 35: 428-434.

23. Popelka S, Hromádka R, Vavřík P, Štursa P, Pokorný D, Jahoda D, Sosna A. Isolated talonavicular arthrodesis in patients with rheumatoid arthritis of the foot and tibialis posterior tendon dysfunction. BMC Musculoskeletal Disorders 2010; 11: 38.

24. Carl HD, Pfander D, Weseloh G, Swoboda B. Talonavicular Arthrodesis for the Rheumatoid Foot. Zeitschrift für Rheumatologie 2006; 65: 633-6: 638-9.

25. Harper MC, Tisdel CL. Talonavicular Arthrodesis for the painful adult acquired flatfoot. Foot Ankle Int 1996; 17: 658-661.

26. Ljung P, Kaij J, Knutson K, Pettersson H, Rydholm U. Talonavicular Arthrodesis in the Rheumatoid Foot. Foot Ankle 1992; 13: 313-316.

27. Chen CH, Juany PJ, Chen TB, Cheby YM, Lin SY, Chiang HC, Chen LC. Isolated Talonavicular Arthrodesis for talonavicular Arthritis. Foot Ankle Int 2001; 22. 633-636.

28. Chiodo CP, Martin T, Wilson MG. A Technique for Isolated Arthrodesis for Inflammatory Arthritis of the Talonavicular Joint. Foot Ankle Int 2000; 21:3 07-310.

29. Suckel A, Miller O, Herberts T, Langenstein P, Reize P, Wolker N. Talonavicular Arthrodesis or Triple Arthrodesis – Peak Pressure in the Adjacent joints measured in 8 cadaver specimen. Acta Orthopaedica 2007; 78: 595-597.

30. Suckel A, Miller O, Herberts T, Wolker N. Changes in Chopart joint load following tibiotalar arthrodesis: in vitro analysis of 8 cadaver specimen in a dynamic model. BMC Musculoskeletal Disorders 2007; 8: 80.

Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#