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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
PubMed
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.

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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.

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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.