The difficult diagnosis of posterior tibialis tendon rupture in sports injuries

Abstract

Posterior tibialis tendon rupture is a diagnosis that is often missed in sports-related injuries. This is thought to be secondary to the nonspecific clinical findings in healthy, active individuals, and the lack of any laboratory or radiographic test to reliably confirm the diagnosis. We report five cases of surgically confirmed posterior tibialis tendon rupture secondary to sports-related trauma. Based on our review of these patients, the diagnosis of posterior tibialis tendon rupture should be strongly suspected in the adult patient presenting with a history of a twisting ankle injury, especially in the setting of high-impact loading and generalized medial ankle pain and swelling. A flexible asymmetric pes planus and forefoot pronation deformity with absence of posterior tibialis tendon function on manual testing is seen on examination. The patient is usually unable to perform ipsilateral single leg heel rise and has less severe pes planus of the contralateral foot. This study reviews the presentation, pathophysiology, diagnosis, and treatment of posterior tibialis tendon rupture.