SLR - September 2010 - Elizabeth Cherry
Reference: Donovan, A., Rosenberg, Z.S. 2009. Extraarticular Lateral Hindfoot Impingement With Posterior Tibial Tendon Tear: MRI Correlation. American Journal of Roentgenology, 193:672-678.
Scientific Literature Reviews
Reviewed by: Elizabeth Cherry, DPM
Residency Program: University Hospitals Richmond Heights Medical Center/Ohio College of Podiatric Medicine
Podiatric Relevance:
Posterior tibial tendon dysfunction (PTTD) has been correlated with the presence and severity of secondary pathologies, such as hindfoot valgus and lateral osseous impingement. This correlation can be useful when planning surgical intervention to assess the complexity and extent of correction required.
Methods:
Confirmed posterior tibial tendon tears based on magnetic resonance (MR) image reviews were identified using a radiology database. Seventy five patients were included in this retrospective study, including 45 women and 30 men. Two musculoskeletal radiologists reviewed the MRI studies using the Rosenberg and Conti classifications of PTTD. The grade of the posterior tibial tendon tear was evaluated, as well as secondary changes such as hindfoot valgus angle, osseous contact and signal changes at opposing surfaces of the lateral talus, calcaneus and fibula, peroneal tendon subluxation or dislocation, and presence of a lateral malleolar bursa.
Results:
Higher grades of posterior tibial tendon tears were significantly correlated with greater values of the hindfoot valgus angle, as well as prevalence of talocalcaneal-subfibular impingement. A total of twenty-eight cases of lateral hindfoot impingement were identified in the study, including six talocalcaneal, eight subfibular and fourteen talocalcaneal-subfibular impingements. Subluxation of the peroneal tendons was found only in cases with advanced hindfoot valgus and impingement. No significant correlation was found between the severity of hindfoot valgus and presence of a lateral malleolar bursa.
Conclusion:
The presence and severity of extraarticular lateral hindfoot impingement can be positively correlated with grading of posterior tibial tendon tears with MR imaging. Peroneal tendon subluxation can be associated with advanced posterior tibial tendon dysfunction. Although medial ankle pain is a dominate symptom in early posterior tibial tendon dysfunction, lateral ankle pain associated with hindfoot valgus and lateral impingement tends to prevail in cases of advanced and longstanding posterior tibial tendon dysfunction. MR images systematically evaluating these changes can assist in predicting the extent of required osseous surgical correction.