ECTS Abstracts (2015) 1 P273

Tibialis Posterior Tenosynovitis Management: Systematic Review

Raghavendra Marappa Ganeshan1, Igab Hujazi1, David Sochart1 & Naveen Keerthi2

1Pennine Acute Hospitals NHS Trust, Manchester, UK; 2University College Of London, London, UK.

Background: Tibialis posterior tendon (PTT) is the most powerful invertor of the foot and an important dynamic stabiliser of the mid foot. PTT tendinitis and tenosynovitis have been confused with ankle sprain that led to delay in diagnosis and treatment in the past. There are many treatment modalities available for treating the same ranging from conservative orthotic supports, steroid injections and surgical decompression and debridement. The aim was to systematically review the available literature and provide a summary of the treatment options and its effectiveness in managing posterior tibialis tendinitis and tenosynovitis.

Methods: Literature search was made on the 12th December 2014, on EMBASE, MEDLINE, CINHAL and Cochrane databases using Boolean search terms; Posterior AND Tibialis AND Tendon, Tendinitis, Tendonitis, Tensonynovitis and treatment. Search results were limited to peer reviewed articles from year 2000 to 2014, in English language and on humans. Review articles, case series and case reports were included. Data was extracted with PRISMA guidance and checklist by two independent reviewers and summarised.

Results: Fifty-nine abstracts from search results were reviewed and 9 papers were included based on the inclusion and exclusion criteria for further assessment. There were no RCTs. There was combined pool of 85 patients from the included studies. 49 of them had orthotic support with anti-inflammatory medications. 41 of 49 patients were reported to have ‘excellent to good’ recovery. Among the surgical group, 15 patients had tendoscopic tenosynovectomy, 19 patients had open surgical debridement and 2 patients had radiofrequency micotenotomy. 13 out of 15 patients had symptoms resolved and full activities resumed with tendoscopic tenosynovectomy while 17 out of 19 patients noticed improvement with open surgical debridement.

Conclusion: Conservative treatment with appropriate orthotic support and steroid/anti-inflammatory medication appears to effective method and in patients who has failed to respond surgical option to be considered earlier to prevent PTT tears and foot deformities.

Disclosure: The authors declared no competing interests.

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