Tendon Lesions

Tendon lesions usually require referral and/or consultation with a podiatrist or orthopedist to aid in treatment decisions ( F|g 279-3 and Fig 2.7.9.-4.). Tenosynovitis and tendinitis may occur in the foot, usually due to overuse. Patients present with pain over the involved tendon. The flexor hallucis longus, posterior tibialis, and Achilles tendon are most commonly involved. Treatment consists of rest, ice, and oral anti-inflammatory agents. 3°,3.1

FIG. 279-3. Tendons of the foot.

FIG. 279-4. Tendons of the foot.

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FIG. 279-4. Tendons of the foot.

Tendon lacerations are usually traumatic. The usual mechanism of injury is a cut to the dorsal or plantar aspect of the foot. Tendon lacerations should be explored and repaired if the ends of the tendon are visible in the wound. The foot should be casted in dorsiflexion after the repair of extensor tendons, and in equinus after repair of flexor tendons. Unfortunately, tendon repairs in the foot have a relatively high complication and disability rate. Specialty consultation is appropriate. 3 31

Spontaneous rupture of the Achilles, tibialis anterior, and posterior tibialis tendons is fairly common. Diagnosis and proper treatment of tendon ruptures is aided by ultrasound, CT scanning, and MRI studies. Orthopedic consultation should be obtained to aid in proper therapeutic decisions. Achilles tendon ruptures are usually due to forceful dorsiflexion and occur more commonly in males. Patients present with pain, a palpable defect in the area of the tendon, and inability to stand on tiptoes. Squeezing the calf of the prone patient whose knee is flexed at 90° will normally cause the foot to plantar flex. This response will be absent in patients with Achilles tendon ruptures. Treatment is generally surgical in younger patients and conservative (casting in equinus) in older patients. 3 31

Ruptures of the anterior tibialis tendon are rare. These usually occur after the fourth decade and are not excessively painful. Patients present with varying degrees of foot drop and a palpable defect distal to the ankle joint in the area of the tendon. In most cases, disability is minimal and surgery is not necessary. 3031

Spontaneous ruptures of the posterior tibialis tendon also occur after the fourth decade. Two-thirds of these cases occur in women. The presentation is usually chronic and insidious. Patients notice a gradual flattening of their arch, with modest discomfort and swelling over the medial ankle. Examination reveals absence of the tendon's normal prominence and weakness on inversion of the foot. Patients find it impossible to stand on tiptoes. Treatment may be conservative or surgical, depending on the duration of the tear and activity of the patient. 3 31

Another tendon rupture of note is rupture of the flexor hallucis longus, which presents as a loss of plantar flexion of the great toe. This lesion must be repaired in ballet dancers but not in the nonathlete.3 31

Disruption of the peroneal retinaculum can occur as a result of a blow during dorsiflexion of the foot. Besides pain localized to the peroneal tendon behind the lateral maleoles, the patient complains of a clicking when walking as the tendon subluxes. Treatment is generally surgical repair.

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