Management of Posterior Tibial Tendon Dysfunction in Neglected Navicular Accessory Fracture: A Case Report

Abstract

Introduction: Posterior tibialis tendon dysfunction (PTTD) is the result cause by degeneration or inflammation of the tendon with subsequent functional impairment secondary to elongation or rupture. Degeneration may be initiated by a traumatic incident but more often is insidious and without an identifiable antecedent trauma. Treatment of PTTD is based on an accurate staging of the disease with both nonsurgical and surgical treatments designed to correct the abnormalities particular to that stage of disease and to prevent progression to the next stage.

Methods: We present a case of a 68-year-old female who had chronic medial ankle pain after slipped and feel down from the stairs with foot flex outward. This patient diagnosed with moderate Acquired Flat Foot Deformity cause by stage II PTTD that associated with history of trauma that previously cause a fracture on the accessory navicular bone. The patient was planned to perform surgical management by doing calcaneal osteotomy and tendon repair of the posterior tibialis tendon by a medial approach incision on the left foot.

Result: We reported an evaluation of VAS and AOFAS Midfoot score before operation result are 8/10 and 50/100. Reevaluation of 3 month after surgery, the patient has improvement on VAS and AOFAS Midfoot score reported on 1/10 and 80/100. There is improvement in active range of motions of the left ankle and patient also can perform a single heel rise with her left foot although still have limitation on the duration and distance.

Conclusion: It can be challenging to decide on the best surgery and create a treatment plan based on the deformity's development. For the effective treatment of each individual patient, it is critical to decide the various surgical and conservative treatments. Because of the progressive tendency of this deformity, many people will require surgical intervention.