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Posterior tibial tendon dysfunction in rheumatoid arthritis
J Michelson1, M Easley, F M Wigley
1Department of Orthopaedic Surgery, Johns Hopkins Hospital and Medical Institutions, Baltimore, Maryland, USA.
Foot & Ankle International
|March 1, 1995
Summary
Rheumatoid arthritis hindfoot deformities, like planovalgus, can stem from posterior tibial tendon dysfunction. This dysfunction, characterized by arch collapse and heel-rise issues, impacts patient mobility and requires attention in rheumatoid arthritis management.
Area of Science:
- Orthopedics
- Rheumatology
- Podiatry
Background:
- Hindfoot pathology is a major cause of disability in rheumatoid arthritis patients.
- The exact cause of planovalgus deformity in rheumatoid arthritis remains debated.
- Posterior tibial tendon dysfunction is a suspected contributor to hindfoot deformities.
Purpose of the Study:
- To investigate the prevalence and severity of hindfoot pathology in rheumatoid arthritis patients.
- To assess the role of posterior tibial tendon function in rheumatoid arthritis-associated planovalgus deformity.
Main Methods:
- Surveyed 99 rheumatoid arthritis patients for hindfoot pathology.
- Evaluated posterior tibial tendon function using manual testing and specific clinical signs.
- Applied stringent diagnostic criteria including loss of arch, impaired heel-rise, and absent tendon palpation.
Main Results:
- Posterior tibial tendon dysfunction was identified in 13% to 64% of patients, depending on criteria.
- Using the strictest criteria (arch loss, heel-rise inability, absent tendon), 11% had dysfunction.
- Demonstrated a link between posterior tibial tendon dysfunction and planovalgus deformity in rheumatoid arthritis.
Conclusions:
- Planovalgus deformity in rheumatoid arthritis can result from evident posterior tibial muscle-tendon unit dysfunction.
- A complex interaction exists between inflammatory joint disruption and tendinous dysfunction.
- Clinical distinction between primary instability and tendon rupture is less critical due to similar treatment approaches.