Treatment Options

Inflammation involving the paratenon (paratendonopathy) may be treated with activity modification, physical modalities, and anti-inflammatory medications. Limb immobilization with a removable boot or cast is generally reserved for recalcitrant cases. A custom foot orthosis directly accommodates abnormal foot mechanics. Achilles tendon stretching and posterior tibialis muscle strengthening may also be helpful.

A steroid injection into the tendon sheath is not recommended. Recalcitrant paratendonopathy may respond to tendon sheath debridement. Moreover, longitudinal tears (or splits) are treated with debridement or repair. Central one third longitudinal tears may be repaired in side-to-side fashion with a running stitch; peripheral tears are generally debrided.

McCormack et al34 reported on eight competitive athletes with an average age of 22 who underwent surgical debridement of their posterior tibial tendons following failure of conservative management. At an average follow-up period of 22 months, seven of the eight athletes were able to return to their previous level of competition. The eighth athlete was able to return to sport but had some intermittent symptoms.

Stage II and III posterior tibial tendon pathology is uncommon in young athletes. Tendonosis with elongation of the tendon occurs in Stage II. As the tendon lengthens, it becomes dysfunctional (Fig. 70-19). Diminution of posterior tibial tendon forces creates an unbalanced foot. The longitudinal arch collapses. The hindfoot shifts into valgus and the forefoot into abduction. These deformities remain flexible. Conservative management of Stage II pathology is bracing with an ankle-foot-orthosis or UCBL shoe inserts. Surgical treatment is most commonly undertaken in the form of a combined tendon transfer (usually the FDL) and medial-translation osteotomy of the cal-caneus, or with lateral column lengthening procedures. Stage III disease develops when the deformities are no longer passively correctible. Arthrodesis is the most common form of operative intervention.

Figure 70-19 Magnetic resonance imaging of a posterior tibial tendon. The arrow demonstrates an abnormal intrasubstance signal of the posterior tibial tendon without tendon disruption. A normal tendon would be oval shaped and homogeneous. This magnetic resonance imaging study is pathology consistent with type II dysfunction.

Figure 70-19 Magnetic resonance imaging of a posterior tibial tendon. The arrow demonstrates an abnormal intrasubstance signal of the posterior tibial tendon without tendon disruption. A normal tendon would be oval shaped and homogeneous. This magnetic resonance imaging study is pathology consistent with type II dysfunction.

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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