Decompressive Medial Cuneiform Exostectomy for Resistant Tibialis Anterior Insertional Tendinopathy

Area of Science:

• Foot and Ankle Surgery
• Orthopedic Surgery
• Sports Medicine

Background:

• Distal tibialis anterior tendinopathy is a recently documented clinical entity.
• It often presents as recalcitrant medial midfoot pain and disability, unresponsive to conservative treatments.

Purpose of the Study:

• To evaluate the efficacy of medial cuneiform decompressive exostectomy and superficial tibialis anterior tendon debridement for recalcitrant insertional tendinopathy.
• To assess pre- and postoperative pain scores, functional outcomes, and patient satisfaction.

Main Methods:

• A review of 13 patients (14 feet) who underwent surgical intervention for tibialis anterior insertional pain.
• Procedures included debridement of the insertional tendon and decompressive exostectomy of the medial cuneiform.
• Outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale and visual analog scale (VAS) pain scores, along with clinical findings and dorsiflexion power.

Main Results:

• Significant reduction in VAS pain scores from a mean of 8.7 to 0.4 (p<0.001).
• Significant improvement in AOFAS midfoot scale scores from a mean of 54 to 91 (p<0.001).
• All patients reported resolved local tenderness and normal dorsiflexion power, with high satisfaction rates.

Conclusions:

• A combination of medial cuneiform decompression and insertional tibialis anterior tendon debridement provides successful outcomes for resistant insertional tibialis anterior tendinopathy.
• This surgical approach offers a viable solution for patients with persistent midfoot pain due to this condition.