Prevalence of Asymptomatic Posterior Tibial Tendinopathy
F. Baker Mills IV, MS; Kevin Williams, MD; Chris Chu, MD; Paul Bornemann, MD; J. Benjamin Jackson III, MD
Posterior tibial tendon dysfunction (PTTD) is a pathological condition that can cause failure of the posterior tibial tendon (PTT). Initially, patients with PTTD are often asymptomatic, making the early identification and treatment challenging. Certain ultrasound (US) characteristics have been implicated in the presence of tendinopathy, but their frequency has yet to be assessed in the PTT. The purpose of this study was to identify and report on the frequency of incidental, or potentially early subclinical, tendinopathic US characteristics in asymptomatic PTTs.
Methods
Following IRB approval, 150 participants underwent a bilateral-comprehensive US assessment. The resulting images were reviewed and assessed to identify the presence of abnormalities demonstrated to represent tendinopathy.
Results
Overall, 266 tendons were assessed and 128 (48.1%) were determined to have at least one tendinopathic trait. Specifically, 51 (26.3%) had circumferential fluid, 69 (35.6%) had non-circumferential fluid, 22 (11.3%) had thickening, 31 (16.0%) had heterogenicity, 19 (9.79%) had hyperemia, and 2 (1.03%) had calcification. Additionally, Caucasian participants were found to be nearly three times more likely to have tendinopathic findings, when compared with African Americans participants.
Conclusion
Sixty-seven percent of participants and 48.1% of PTTs evaluated had at least one tendinopathic feature identified on ultrasound. The prevalence of these findings, observed in participants, were as follows: non-circumferential fluid (45.1%), circumferential fluid (30.1%), heterogenicity (20.3%), and thickening (13.5%). Knowing the frequency of these traits may help clinicians to identify subclinical tendinopathy in the PTT, before progressing to PTTD.
Level of Evidence
Level IV