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. 2024 Jul 16;21(10):1876-1883.
doi: 10.7150/ijms.98222. eCollection 2024.

Correlation of Posterior Tibial Tendon Ultrasound with Calcaneal Inclination Angle in Indonesian Professional Athletes with Medial Ankle Pain

Rosy Setiawati  1 , Alfian Hasbi  1 , Paulus Rahardjo  1 , Damayanti Tinduh  2 , Alit Pawana  2 , Vincent Geraldus Enoch Lusida  3 , Giuseppe Guglielmi  4 , Suresh Mukherji  5
Affiliations

Correlation of Posterior Tibial Tendon Ultrasound with Calcaneal Inclination Angle in Indonesian Professional Athletes with Medial Ankle Pain

Rosy Setiawati et al. Int J Med Sci. .

Abstract

Background: Adult-acquired flatfoot deformity (AAFD) is characterized by partial or complete flattening of the longitudinal medial arch, which develops after maturity. AAFD secondary to posterior tibialis tendon dysfunction (PTTD) is one of professional athletes' most common foot and ankle pathologies. Different modalities and procedures can be used to establish the diagnosis of AAFD and PTTD. However, imaging measurements such as the calcaneal inclination index and ultrasonography (US) of the posterior tibialis tendon (PTT) in professional athletes with medial ankle and focal pain along the PTT have yet to be widely studied. This study investigates the correlation of PTT ultrasound for evaluating PTTD with calcaneal inclination angle (CIA) for evaluating AAFD in professional athletes with medial ankle and focal pain along the PTT. Through this study, clinicians and radiologists may benefit from considering AAFD in athletes with PTTD. Methods: 112 Indonesian professional athletes with medial ankle or foot pain and focal pain along the direction of the PTT underwent foot radiography using the CIA and ankle ultrasound to observe PTT abnormalities. Results: A negative correlation between fluid thickness surrounding the PTT and the CIA (p<0.001; 95% CI - 0.945, - 0.885), as well as a negative correlation between PTT thickness and CIA (p<0.001, 95% CI - 0.926, - 0.845), with a correlation coefficient (r) of - 0.921 and - 0.892, respectively. No significant correlation was found between PTT tear and CIA (p = 0.728; 95% CI -0.223, - 0.159; r - 0.033). Conclusion: This study showed a negative correlation between PTTD and AAFD via ultrasound and CIA in professional athletes with medial ankle and focal pain along the PTT. A better understanding of PTTD and AAFD imaging will lead to more effective management and prompt treatment.

Keywords: AAFD; Calcaneal inclination angle; PTTD; Posterior tibialis tendon dysfunction; adult acquired flatfoot deformity; tear; tenosynovitis; ultrasound.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Transducer positioning for posterior tibial tendon ultrasound scanning positioning of lateral x-ray weight bearing foot.
Figure 2
Figure 2
Transverse sonographic of posterior tibialis tendon with tenosynovitis showed thickening of the tendon fiber (A) with fluid in the tendon sheath (B).
Figure 3
Figure 3
Longitudinal sonographic of posterior tibialis tendon with partial tear.
Figure 4
Figure 4
Positioning of lateral x-ray weight bearing foot.
Figure 5
Figure 5
Lateral radiograph shows the calcaneal inclination angle.
See this image and copyright information in PMC

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