IS THERE A ROLE FOR SURGICAL DECOMPRESSION IN STAGE I TIBIALIS POSTERIOR TENDON DYSFUNCTION?

Abstract

Tibialis posterior tendon (TPT) dysfunction is a disorder of unknown aetiology. Trauma, inflammatory processes, anatomical abnormalities and iatrogenic factors have all been implicated as causative mechanisms. The condition presents with pain and swelling around the medial malleolus. The pain is characteristically worse on exercise and relieved by elevation. The disorder has been classified by Johnson and Strom (1989); stage I is characterized by pain around the medial malleolus and mild weakness of single heel raising. Without treatment the condition may progress to a fixed valgus deformity along with pes planus.

Aim

To assess the outcome of surgical decompression of stage I TPT dysfunction.

Method

Ten cases were identified, operated on by a single surgeon over a three-year period. The patients were assessed in a dedicated clinic by administration of a questionnaire and by clinical examination.

Results

Nine patients with an average age of 30 years (13–51) agreed to participate in the study. Six of the nine patients recalled a sporting injury to the ankle prior to onset of symptoms. Eight of these of patients underwent a course of physiotherapy prior to surgery. After decompression all patients reported reduction of pain as measured using a visual analogue scale, with five patients reporting complete resolution of pain. Patients experienced relief of pain on average four weeks (1.5–6) after surgery. All patients were able to return to work and normal leisure activities after appropriate rehabilitation.

Conclusions

Decompression of the tibialis posterior tendon in stage I dysfunction leads to pain relief and enables an early return to normal activities. Therefore surgical decompression of the tibialis posterior tendon may be considered in cases of stage I dysfunction which are refractory to conservative measures, particularly in young and active patients.