Search Our Scientific Publications & Authors

Am Fam Physician 2022 May;105(5):479-486

The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Tendinopathies of the foot and ankle, including posterior tibial, peroneal, and tibialis anterior, are commonly overlooked by primary care physicians. The posterior tibial tendon is the main dynamic stabilizing muscle of the medial longitudinal arch. Patients who have posterior tibial tendinopathy present with medial ankle pain, pes planovalgus deformity, and a positive too many toes sign. Read More

Eur J Radiol 2022 May 9;150:110227. Epub 2022 Mar 9.

Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium. Electronic address:

Purpose: To determine the normal thickness and MRI appearance of the Tibialis Posterior Tendon near the navicular insertion in normal volunteers.

Materials And Methods: By using a 3T MRI system 41 ankles were imaged, and PD weighted images with fat saturation were acquired in the three orthogonal planes. Symptoms of tendon pathology and history of trauma or surgery of the tendon were used as volunteer exclusion criteria. Read More

Arch Orthop Trauma Surg 2022 Jan 18. Epub 2022 Jan 18.

Department of Orthopaedics, Centro Hospitalar e Universitário do Porto, Porto, Portugal.

Purpose: The aims of this study were: (1) to define the incidence of tendinous injuries in calcaneus and pilon fractures with different fracture severity and (2) to determine the clinical impact of such injuries.

Study Design And Methods: CT-scans of 121 patients with calcaneus and pilon fractures were retrospectively analyzed over a 4-year period. The tendinous injuries were identified and correlated with the type of fracture (location and classification). Read More

BMJ Case Rep 2022 Jan 17;15(1). Epub 2022 Jan 17.

Sports Medicine and Rehabilitation Clinic Sports Traumatology Center, Tartu University Hospital, Tartu, Tartumaa, Estonia.

Traumatic dislocation of the tibialis posterior tendon is an extremely rare injury with few reported cases. It is a complicated injury with high risk of misdiagnosis and mistreatment. MRI is the best tool for diagnosis. Read More

Acta Radiol 2022 Apr 11;63(4):481-488. Epub 2021 Jul 11.

Graduate Program in Physical Education Sciences, University of Brasília (UnB), Brasília, Brazil.

Background: The cross-sectional area (CSA) records make an essential measurement for determining the mechanical properties of tendons, such as stress and strength. However, there is no consensus regarding the best method to record the CSA from different tendons.

Purpose: To determine intra- and inter-rater reliability for CSA measures from magnetic resonance imaging (MRI) of the following tendons: tibialis anterior; tibialis posterior; fibularis longus and brevis; and Achilles. Read More

Acta Radiol 2022 Jul 29;63(7):942-947. Epub 2021 May 29.

Department of Nuclear medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Background: The evaluation of correlations among joint effusion, ligament injuries, tenosynovitis and osteochondral lesion of talus (OLT) in the ankle joint is important for developing a treatment plan and predicting prognosis.

Purpose: To evaluate correlations among tibiotalar (anterior) and talocalcaneal (posterior) joint effusion, tenosynovitis of major flexor tendons, ligaments, and OLT in a group of patients with ankle trauma.

Material And Methods: This retrospective study included 101 patients with ankle trauma who underwent magnetic resonance imaging. Read More

Foot Ankle Surg 2022 Apr 18;28(3):402-408. Epub 2021 May 18.

Graduate Program in Physical Education Sciences, University of Brasília (UnB), Federal District, Brazil; Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil.

Background: Acute lateral ankle sprain (LAS) is the most prevalent acute sports trauma. Ankle muscle atrophy and tendon volume decrease have not been analyzed concomitantly with functional impairment and pain following LAS. The objective of the present study was to investigate muscle cross-section area (CSA), tendon CSA and volume, ankle function, and pain in individuals who suffered an acute LAS. Read More

Foot Ankle Surg 2022 Apr 15;28(3):319-323. Epub 2021 Apr 15.

Hospital Beatriz Ângelo, Portugal.

Background: Associations of tendon injuries with ankle and hindfoot fractures is a current concern and recent research has linked specific fractures with specific tendon injuries, despite its functional impact being unknown. The purpose of this study is to assess that impact.

Methods: Computed tomography scans of patients with ankle and hindfoot fractures were reviewed for tendon injuries. Read More

J Orthop Sports Phys Ther 2021 05 28;51(5):253-260. Epub 2021 Mar 28.

Objective: To determine the reliability of common clinical tests for tibialis posterior tendinopathy (TPT) and to investigate their relationship with grayscale ultrasound findings in individuals who have medial foot/ankle pain.

Design: Prospective cohort.

Methods: Fifty-two individuals reporting medial foot/ankle pain were clinically examined by 2 physical therapists using 4 clinical tests for TPT: pain on tendon palpation, swelling around the tendon, pain/weakness with tibialis posterior contraction, and pain during or inability to perform a single-leg heel raise (SLHR). Read More

Foot Ankle Surg 2021 Dec 1;27(8):874-878. Epub 2020 Dec 1.

Ankara University Faculty of Medicine, Department of Orthopaedics and Traumatology, Department of Hand Surgery, Talatpasa Blv No:82 Altindag, Ankara, Turkey.

Background: Covering soft tissue defects of the distal one-third of the leg and the Achilles tendon region and is a challenging problem for an orthopedic surgeon. With recent advancements in the anatomical knowledge of perforating vessels, perforator-pedicled propeller flaps have become increasingly popular in recent decades. We aimed to evaluate the clinical outcomes of our patients whose soft tissue defects in the distal leg were reconstructed with propeller flaps and assessed association of complications with age, gender, flap size and arc of rotation. Read More

J Foot Ankle Surg 2021 Jan-Feb;60(1):199-203. Epub 2020 Sep 3.

Section of Orthopedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.

Although replantation of an amputated extremity has been successfully performed, occasionally the surgeon is forced to amputate in the case of an unsalvageable open fracture. These appendages can theoretically act as an autologous 'bone and tissue bank' for patients if they have reconstructable contralateral injuries. We present a case of an athlete who sustained a Gustilo and Anderson IIIC injury on 1 leg resulting in a below knee amputation. Read More

Clin Sports Med 2020 Oct 13;39(4):859-876. Epub 2020 Aug 13.

Institute for Foot and Ankle Reconstruction, Mercy Medical Center, 301 St. Paul Place, Baltimore, MD 21202, USA.

Painful accessory navicular and spring ligament injuries in athletes are different entities from more common posterior tibialis tendon problems seen in older individuals. These injuries typically affect running and jumping athletes, causing medial arch pain and in severe cases a pes planus deformity. Diagnosis requires a detailed physical examination, standing radiographs, and MRI. Read More

JBJS Case Connect 2020 Apr-Jun;10(2):e1900590

1Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal.

Case: A 37-year-old man presented after a sudden snap followed by pain in the medial side of the ankle while playing football. Physical examination showed edema and pain posteriorly to the medial malleolus, and a longitudinal structure was palpable anteriorly. Ultrasound confirmed a dislocated tibialis posterior tendon (TPT). Read More

J Foot Ankle Surg 2020 Sep - Oct;59(5):1058-1061. Epub 2020 Apr 29.

Assistant Professor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation, Hospital/Harvard Medical School, Charlestown, Massachusetts. Electronic address:

Tibialis posterior tendinopathy is a common debilitating condition seen by foot and ankle providers. Non-operative management is difficult as patients often present in later stages of the disease. This case series evaluated the combination of radial shockwave therapy and a foot core progression exercise regimen on 10 patients who had failed standard conservative treatment techniques. Read More

J Foot Ankle Surg 2020 May - Jun;59(3):469-478

Orthopaedic Surgeon, Foot and Ankle Department, Clínica Bazterrica, Buenos Aires, Argentina.

Patients with acquired flatfoot deformity due to isolated injury of the spring ligament, with healthy posterior tibialis tendon, are rarely identified. Between December 2004 and September 2011 (6 years and 9 months), we treated 10 patients with acquired flatfoot deformity due to spring ligament injury without tibialis posterior tendon tear. One patient (10%) was lost to follow-up. Read More

Am J Phys Med Rehabil 2020 10;99(10):961-967

From the Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey (JB); Burke Rehabilitation Hospital, White Plains, New York (MO-P); Arthur S. Abramson Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Montefiore Health System, New York City, New York (MO-P); Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia (HLL); University of Hawaii School of Medicine, Honolulu, Hawaii (HLL); and Department of Physical Medicine & Rehabilitation, VA New Jersey Health Care System, East Orange, New Jersey (RTM).

Despite the high incidence of foot and ankle injuries and their biomechanical importance to more proximal joints, the foot and ankle are some of the most daunting and underemphasized musculoskeletal structures in medical training. This study used musculoskeletal ultrasound to identify a knowledge gap in physical medicine and rehabilitation residents in foot and ankle surface anatomy palpation and to determine whether senior residents had higher examination performance compared with more junior residents. Physical medicine and rehabilitation residents at different levels of training were tested cross-sectionally, and palpation accuracy was compared by class year. Read More

Foot Ankle Int 2020 04 22;41(4):473-478. Epub 2019 Dec 22.

Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Background: Technical innovation now offers the possibility of 2-mm-diameter operative tendoscopy with disposable arthroscopes and tablet-like control units. The promises of new technology should be critically scrutinized. Therefore, this study assessed whether 2-mm-diameter operative tendoscopy of the tibialis posterior, peroneal, and Achilles tendons was safe and effective in a cadaveric model. Read More

Injury 2020 Feb 4;51(2):527-531. Epub 2019 Oct 4.

Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address:

Background: Surgical fixation of syndesmotic instability using quadricortical fixation, whether screws or suture-button devices, places structures on the medial side of the tibia at iatrogenic risk. This study aims to radiographically map the anatomic course of structures on the medial aspect of the distal tibia to be able to at-risk zones (ARZs) for syndesmotic fixation.

Methods: Eighteen fresh-frozen cadaveric ankle specimens were dissected. Read More

Br J Radiol 2019 Dec 17;92(1104):20190722. Epub 2019 Oct 17.

Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.

Objective: It has been stated that the distal 1-2 cm of the tibialis posterior tendon (TPT) does not have a tendon sheath but rather a paratenon, and that any fluid seen around this segment on ankle MRI is considered to represent paratendonitis. The prevalence and clinical significance of isolated TPT paratendonitis diagnosed on ankle MRI is unknown. This study aims to correlate the presence of isolated distal segment TPT paratendonitis on ankle MRI, with the presence or absence of medial midfoot pain. Read More

Br J Radiol 2019 Dec 11;92(1104):20190221. Epub 2019 Oct 11.

Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000 Vail, Colorado 81657, United States.

Objective: Early detection of tibialis posterior tendon changes and appropriate intervention is necessary to prevent disease progression to flat-foot deformity and foot/ankle dysfunction, and the need for operative treatment. Currently, differentiating between early-stage tibialis posterior tendon deficiency patients who will benefit from conservative more aggressive treatment is challenging. The objective of this work was to establish a quantitative MRI T2* mapping method and subregion baseline values in the tibialis posterior tendon in asymptomatic ankles for future clinical application in detecting tendon degeneration. Read More

Radiol Case Rep 2019 Sep 17;14(9):1144-1147. Epub 2019 Jul 17.

Department of Radiology, University of Washington, 4245 Roosevelt Way N.E., Seattle, WA 98105, USA.

Medial flexor retinaculum injuries are not uncommon, but medial flexor retinaculum periosteal avulsion injuries are rare. This patient sustained a medial flexor retinaculum tear readily characterized at computed tomography by an associated proximal retinacular avulsion fracture from the posteromedial tibia. Medial flexor retinaculum injury is often also associated with superficial deltoid pathology and/or medial malleolar fracture. Read More

J Foot Ankle Surg 2019 Sep 29;58(5):995-1001. Epub 2019 May 29.

Department of Podiatric Surgery and Medicine at Mount Sinai Beth Israel Medical Center, New York, NY.

Tibialis posterior (TP) tendon ruptures are common after ankle injuries, degenerative processes, or biomechanical instability. The TP tendon decelerates the subtalar joint pronation and internal rotation of the leg during the contact phase. It also plantarflexes and inverts the foot on the leg during the static phase of gait. Read More

Foot Ankle Surg 2020 Feb 12;26(2):224-227. Epub 2019 Mar 12.

Department of Orthopaedic Surgery and Rehabilitation, University of Vermont College of Medicine, Robert T. Stafford Hall, 4th Floor, 95 Carrigan Drive, Burlington, VT 05405-0084 United States. Electronic address:

MRI is frequently used in the evaluationand treatment of tibialis posterior tendon (PTT) dysfunction. MRI is reported to have sensitivity up to 95%, with 100% specificity, in the detection of rupture of the PTT. We present three cases where MRI demonstrated complete or partial rupture of the PTT, where subsequent surgery showed an intact PTT with tenosynovitis. Read More

J Med Case Rep 2018 Nov 23;12(1):348. Epub 2018 Nov 23.

Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan.

Background: Traumatic dislocation of the tibialis posterior tendon at the ankle is a rare injury. Some of these cases are misdiagnosed as ankle sprains and are not treated properly. In addition, because the conservative treatment is not as effective as the surgical treatment, it is essential that patients be diagnosed early so that proper surgical treatment can be performed. Read More

J Foot Ankle Surg 2019 Jul 15;58(4):647-652. Epub 2018 Nov 15.

Surgeon, Department of Orthopedic Surgery, Sports Medicine, Bellevue University Medical Center, Mansourieh, Lebanon.

We report the case of a 32-year-old basketball player who presented with an acute flatfoot deformity after performing a unipodal power jump. Rupture of the posterior tibial tendon within the foot was diagnosed and then treated by hamstring tendon transfer combined with application of autologous biologic preparations. The functional outcome at 18 months was good. Read More

J Ultrasound Med 2019 Apr 12;38(4):917-926. Epub 2018 Sep 12.

School of Health Sciences, University of Salford, Salford, UK.

Objective: Ankle sprains constitute approximately 85% of all ankle injuries, and up to 70% of people experience residual symptoms. While the injury to ligaments is well understood, the potential role of other foot and ankle structures has not been explored. The objective was to characterize and compare selected ankle structures in participants with and without a history of lateral ankle sprain. Read More

J Foot Ankle Surg 2018 Nov - Dec;57(6):1267-1271. Epub 2018 Jul 13.

Professor, Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan.

Dislocation of the tibialis posterior tendon (PTT) is a rare traumatic injury, and treatment is often delayed. Conservative treatment is ineffective for recurrent dislocation of the PTT; however, a reference standard procedure has not yet been established. In the present case report, we describe an innovative pseudo-pouch closing procedure with suture tape and a suture anchor for recurrent PTT dislocation. Read More

Foot Ankle Int 2018 08 11;39(8):984-989. Epub 2018 Apr 11.

2 Orthopedic Foot and Ankle Center, Westerville, OH, USA.

Background: The center-center technique for syndesmosis fixation has been described as an improved and reliable technique for proper reduction of the syndesmosis during ankle fracture repair. Concurrently, the use of flexible fixation with a suture button is becoming an established means of syndesmosis stabilization. The purpose of this cadaveric study was to assess for medial structure injury during the placement of a suture button using the center-center technique for ankle syndesmosis repair at 3 insertion intervals. Read More

Foot Ankle Int 2018 04 16;39(4):433-442. Epub 2018 Feb 16.

3 Clinique de l'Union, Ankle and Foot Surgery Center, Saint-Jean, France.

Background: Stage II tibialis posterior tendon dysfunction (PTTD) resistant to conservative therapies is usually treated with invasive surgery. Posterior tibial tendoscopy is a novel technique being used in the assessment and treatment of posterior tibial pathology. The aims of this study were (1) to clarify the role of posterior tibial tendon tendoscopy in treating stage II PTTD, (2) to arthroscopically classify spring ligament lesions, and (3) to compare the arthroscopic assessment of spring ligament lesions with magnetic resonance imaging (MRI) and ultrasonographic (US) data. Read More

Foot Ankle Int 2018 06 15;39(6):712-719. Epub 2018 Feb 15.

1 Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Songpa-gu, Seoul, South Korea.

Background: Selective soft tissue release (SSTR), which includes a combination of abductor hallucis, tibialis posterior, and Achilles lengthening, has been used in patients with recurrent clubfoot deformity after Ponseti treatment. The aim of this study was to investigate the prognostic factors for recurrence of clubfoot deformity after SSTR.

Methods: Consecutive patients with idiopathic clubfoot and residual or recurrent deformity after Ponseti treatment underwent SSTR between 2005 and 2013. Read More