Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 9 , ISSUE 3 ( July-September, 2022 ) > List of Articles


Posterior Tibial Tendoscopy in Flexible Acquired Flatfoot Deformity

Manuel Monteagudo, Pilar Martínez de Albornoz

Keywords : Collapsing foot, Endoscopy, Flatfoot, Magnetic resonance imaging, Posterior tibial tendon, Retrospective cohort study, Synovectomy, Tendoscopy

Citation Information : Monteagudo M, de Albornoz PM. Posterior Tibial Tendoscopy in Flexible Acquired Flatfoot Deformity. J Foot Ankle Surg Asia-Pacific 2022; 9 (3):123-127.

DOI: 10.5005/jp-journals-10040-1241

License: CC BY-NC 4.0

Published Online: 01-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Tendoscopy is a reliable and safe technique to manage some foot and ankle disorders. The technique allows for a view of the entire length of tendons and may be used as an isolated procedure or adjacent to other techniques, such as calcaneal osteotomy. Posterior tibial tendoscopy is a useful tool both for the diagnosis and treatment of different disorders that affect the tendon in isolation (i.e., post-traumatic) or in the scenario of a flatfoot deformity. We will review the technique of posterior tibial tendoscopy and present tips and tricks to optimize the tendoscopic experience. We will also analyze our first 20 consecutive cases of posterior tibial tendoscopy in the setting of a flexible flatfoot deformity and study our data and results. In 10 cases, there were no significant pathological findings on magnetic resonance imaging (MRI) or on tendoscopy. In six cases, synovitis and adhesions were informed on MRI and found on tendoscopy. Preoperative MRI findings were coincident with tendoscopic findings in 16 of the 20 cases (80%). MRI failed to identify two cases of synovitis, a case of synovial plica and suggested a partial tear where tendoscopy demonstrated no structural damage. Although MRI is an effective imaging tool for identifying tendon disorders, tendoscopy seems to be a more sensitive diagnostic tool. Posterior tibial tendon (PTT) tendoscopy has become our procedure of choice in stage IIA AAFD and has allowed us to treat PTT disorders when skipping the medial soft tissue repair with no impact on outcomes while addressing pathology that might cause symptoms if left untreated.

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  1. Wertheimer SJ, Weber CA, Loder BG, et al. The role of endoscopy in treatment of stenosing posterior tibial tenosynovitis. J Foot Ankle Surg 1995;34(1):15–22. DOI: 10.1016/S1067-2516(09)80097-5
  2. van Dijk CN, Knort N, Scholten PE. Tendoscopy of the posterior tibial tendon. J Arthrosc Rel Surg 1997;13(6):692–698. DOI: 10.1016/s0749-8063(97)90002-5
  3. Wacker JT, Hennessy MS, Saxby TS. Calcaneal osteotomy and transfer of the tendon of flexor digitorum longus for stage-II dysfunction of tibialis posterior. Three- to five-year results. J Bone Joint Surg Br 2002;84(1):54–58. DOI: 10.1302/0301-620x.84b1.11847
  4. Arangio GA, Salathe EP. A biomechanical analysis of posterior tibial tendon dysfunction, medial displacement calcaneal osteotomy and flexor digitorum longus transfer in adult acquired flat foot. Clin Biomech (Bristol, Avon) 2009;24(4):385–390. DOI: 10.1016/j.clinbiomech.2009.01.009
  5. Monteagudo M, Maceira E. Posterior tibial tendoscopy. Foot Ankle Clin N Am 2015;20(1):1–13. DOI: 10.1016/j.fcl.2014.10.009
  6. Kong A, Van Der Vliet A. Imaging of tibialis posterior dysfunction. Br J Radiol 2008;81(970):826–836. DOI: 10.1259/bjr/78613086
  7. Shibuya N, Ramanujam CL, Garcia GM. Association of tibialis posterior tendon pathology with other radiographic findings in the foot: a case-control study. J Foot Ankle Surg 2008;47(6):546–553. DOI: 10.1053/j.jfas.2008.08.010
  8. Bulstra GH, Olsthoorn PGM, van Dijk CN. Tendoscopy of the posterior tibial tendon. Foot Ankle Clin 2006;11(2):421–427. DOI: 10.1016/j.fcl.2006.03.001
  9. Bojanić I, Dimnjaković D, Mahnik A, et al. Is there any room for tendoscopy in the surgical treatment of posterior tibial tendon insufficiency? Lijec Vjesn 2016;138(5–6):144–151. PMID: 29182826.
  10. Chow HT, Chan KB, Lui TH. Tendoscopic debridement for stage I posterior tibial tendon dysfunction. Knee Surg Sports Traumatol Arthrosc 2005;13(8):695–698. DOI: 10.1007/s00167-005-0635-8
  11. Khazen G, Khazen C. Tendoscopy in stage I posterior tibial tendon dysfunction. Foot Ankle Clin 2012;17(3):399–406. DOI: 10.1016/j.fcl.2012.06.002
  12. Bernasconi A, Sadile F, Welck M, et al. Role of tendoscopy in treating stage II posterior tibial tendon dysfunction. Foot Ankle Int 2018;39(4):433–442. DOI: 10.1177/1071100717746192
  13. Lui TH. Endoscopic assisted posterior tibial tendon reconstruction for stage 2 posterior tibial tendon insufficiency. Knee Surg Sports Traumatol Arthrosc 2007;15(10):1228–1234. DOI: 10.1007/s00167-006-0282-8
  14. Hua Y, Chen S, Li Y, et al. Artrhoscopic treatment for posterior tibial tendon lesions with a posterior approach. Knee Surg Sports Traumatol Arthrosc 2013;23(3):879–883. DOI 10.1007/s00167-013-2629-2
  15. Monteagudo M, Maceira E, Martinez de Albornoz P. Foot and ankle tendoscopies: current concepts review. EFORT Open Rev 2017;1(12):440–447. DOI: 10.1302/2058-5241.160028
  16. Monteagudo M, Martínez-de-Albornoz P. Progressive collapsing foot deformity. Is there really a Johnson and Strom Stage I? Foot Ankle Clin 2021;26(3):443–463. DOI: 10.1016/j.fcl.2021.05.002
  17. Monteagudo M, Martínez de Albornoz P, Cuervas-Mons M. Tendoscopies in the foot and ankle. Fuß & Sprunggelenk 2021;19(2):76–85. DOI: 10.1016/j.fuspru.2021.04.001
  18. Gianakos AL, Ross KA, Hannon CP, et al. Functional outcomes of tibialis posterior tendoscopy with comparison to magnetic resonance imaging. Foot Ankle Int 2015;36(7):812–819. DOI: 10.1177/1071100715576485
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