Tibialis posterior tendon dysfunction: a primary or secondary problem?
Seventeen patients with a mean follow-up of 64.4 months following a tibialis posterior tendon transfer to regain active foot dorsiflexion were clinically examined specifically for signs of tibialis posterior tendon dysfunction. The results show that 8 patients (47%) had Grade 4 or better power of eversion but none had a clinical flatfoot on the Harris-Beath footprints. Only 6% had forefoot abduction; 17% exhibited hindfoot valgus and 82% were able to perform the single-heel rise. Tibialis posterior tendon dysfunction therefore does not appear to be an inevitable sequel of tibialis posterior tendon transfer even in the presence of a functioning peroneal muscle. Other studies have noted that a pre-existent flatfoot was often present in patients with tibialis posterior tendon dysfunction. None of the patients in this study had pre-existent flatfoot. We suggest that a predisposition, in the form of a pre-existent tendency to flatfoot may also be a factor in the pathogenesis of tibialis posterior tendon dysfunction. This may explain the long-term failure of flexor digitorum longus and flexor hallucis longus tendon transfers in the treatment for tibialis posterior tendon dysfunction when the biomechanics of the foot has not been altered.
Yeap
J S
JS
Royal National Orthopaedic Hospital, Stanmore, Middlesex, England.
Singh
D
D
Birch
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005413:Flatfoot / Q000175:diagnosis* / Q000209:etiology*; D005530:Foot Deformities / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D013640:Tarsal Joints / Q000503:physiopathology; D013709:Tendon Transfer / Q000009:adverse effects*; D013710:Tendons / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome