Operative management of distal tibialis anterior tendinopathy

The results of operative management for distal tibialis anterior tendinopathy (DTAT) without rupture have not previously been described in the literature. We present the results of 12 operative procedures.

Of 40 patients diagnosed clinically and radiographically with DTAT, we reviewed 11 patients who underwent surgery for failure of nonoperative management. Assessment included pre and postoperative AOFAS midfoot scores, clinical examination and postoperative VAS pain scoring, at a mean followup of 29 months.

Ten women (ten feet) and one man (2 feet) underwent surgery. The mean age at surgery was 59 years. The mean duration of symptoms prior to surgery was 1 year. The mean preoperative AOFAS score was 52. Preoperative MRI showed tendinosis in two tendons and tendinosis with longitudinal split tears in ten tendons. Six of the twelve cases showed some associated degenerative changes of the midfoot. Six tendons were simply debrided and the insertion reinforced with a suture anchor. Six tendons were augmented with an extensor hallucis longus (EHL) transfer into the medial cuneiform. All patients improved postoperatively, with a mean improvement in AOFAS score of 33 and the mean postoperative pain VAS of 0.9 out of 10. Two patients underwent concomitant procedures on the same foot. Three of the six treated with EHL transfer have some symptomatic hallux interphalangeal joint extensor lag. In six cases the patient was completely satisfied. Three were satisfied with minor reservations. Of the three that were dissatisfied, two underwent subsequent surgery improving their symptoms. The third, though pain-free, was troubled by her toe-catching when walking barefoot. No patient regretted having had the surgery.

Debridement and repair of DTAT, with EHL augmentation for greater than 50% tendon involvement, provided a high level of patient satisfaction after nonoperative management failed in this series.