title: Unique Case of Posterior Tibial Tendon Dysfunction After Stingray Strike.
abstract: BACKGROUND
  Posterior tibial tendon dysfunction is a common cause of adult acquired flatfoot deformity. The cause of posterior tibial tendon dysfunction is often multifactorial and may include repetitive microtrauma, poor blood supply to the tendon, and, rarely, traumatic rupture.
  
  
  METHODS
  We present the case of a 69-year-old male with posterior tibial tendon dysfunction secondary to a stingray injury that occurred directly into the posterior tibial tendon. This injury led to an acquired adult flatfoot deformity that ultimately required surgical reconstruction. At the time of surgery, the posterior tibial tendon was severely degenerative at the site of skin penetration.
  
  
  METHODS
  Previous case reports of stingray injury describe full-thickness skin penetration with a subsequent inflammatory response and large zone of necrobiosis. This is the first reported case of stingray trauma and envenomation directly into tendon with subsequent tendon dysfunction.
  
  
  CONCLUSIONS
  There are thousands of stingray injuries in the United States annually. Injuries vary in severity depending on the type of stingray, size of stingray, and depth and location of injury. For certain injuries, such as direct penetration into tendon, early irrigation and debridement may limit subsequent deficits caused by progressive tendon dysfunction.
  
  
  METHODS
  Therapeutic, Level IV: Case study.
authors.affiliation: Department of Orthopaedics, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Dustin
authors.initials: D
authors.lastname: Hambright
authors.affiliation: Department of Orthopaedics, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Daniel
authors.initials: D
authors.lastname: Guss
authors.affiliation: Department of Orthopaedics, Brigham and Women's Hospital, Boston, Massachusetts jsmith42@partners.org.
authors.forename: Jeremy T
authors.initials: JT
authors.lastname: Smith
mesh_terms: D000368:Aged; D000818:Animals; D001733:Bites and Stings / Q000150:complications*; D005413:Flatfoot / Q000209:etiology*; D006801:Humans; D008297:Male; D037081:Posterior Tibial Tendon Dysfunction / Q000209:etiology*; D012860:Skates, Fish
keywords: flatfoot; posterior tibialis; stingray; tendon; venom