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


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Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
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