Posterior Tibial Tendon Rupture

Description

Posterior tibial tendon rupture is a complete tear of the posterior tibial tendon. This structure is the tendon attachment of one of the muscles of the leg, the posterior tibialis, to the inner part of the foot. Loss of continuity between the inner leg muscles and the foot results in loss of function of the muscles. The function of the posterior tibialis muscle is to turn the foot inward and forcefully push the front of the foot down, such as when standing on the toes and pushing off with walking, running, or jumping.

Common signs and symptoms

• A pop or rip felt behind the inner part of the ankle

• Pain and weakness with moving the foot, especially when pushing down with the front of the foot or turning it inward

• Weakness or inability to stand on the toes or on the ball of the foot

• Tenderness, swelling, warmth, and redness around the posterior tibial tendon

• Bruising at the heel after 48 hours

• Flat foot (only on the injured side)

Causes

• A sudden episode of stressful overactivity, such as with jumping, hurdling, or starting a sprint

Factors that increase risk

• Sports that require sudden, explosive muscle contraction, such as those involving jumping and quick starts; also with running or contact sports

• Poor physical conditioning (strength, flexibility)

• Previous or untreated posterior tibial tendon injury

• Cortisone injection into the posterior tibial tendon

• Obesity and decreased circulation resulting from cardiovascular problems

Preventive measures

• Appropriately warm up and stretch before practice and competition.

• Allow time for adequate rest and recovery between practices and competition.

• Maintain appropriate conditioning that includes ankle and leg flexibility, muscle strength, endurance, and cardiovascular fitness training.

• Maintain an ideal body weight.

• Arch supports (orthotics), taping, protective strapping, or an adhesive bandage may be recommended before practice or competition.

Expected outcome

Surgery is recommended to allow the greatest likelihood of return to full activity with the least risk of complications. Sports usually can be resumed after 4 to 9 months.

Possible complications

• Weakness of the posterior tibial muscles, especially if untreated, resulting in problems standing on the toes and pushing off

• Re-rupture of the tendon after treatment

• Prolonged disability

• Flat feet

• Arthritis of the foot

• Risks of surgery, including infection, injury to nerves (numbness, weakness), bleeding, and pain

General treatment considerations

Initial treatment consists of staying off the affected leg, icing the area, applying a compressive elastic bandage, and elevating the injured leg to eye level. Definitive treatment options include surgical and nonsurgical intervention.

• Nonsurgical treatment is usually reserved for patients with medical problems or after chronic injury.

• Surgical treatment usually involves sewing the ends of the tendon back together, followed by immobilization in a cast, usually a short leg cast, below the knee to the toes. If the injury is not acute, reconstruction using another tendon to replace the function of the torn posterior tibial tendon is often recommended, if there is no arthritic change in the foot already. This is because the tendon often cannot be repaired in chronic (old) injuries. If arthritis exists, fusion of the affected joints usually is recommended.

Medication

• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

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