Hintermann B, Knupp M
Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Orthopädische Klinik Kantonsspital, Rheinstraße 26, CH-4410 Liestal, Schweiz.
Orthopade. 2010 Dec;39(12):1148-57. doi: 10.1007/s00132-010-1692-3.
The function of the posterior tibial (PT) tendon is to stabilize the hindfoot against valgus and eversion forces. It functions as the primary invertor of the foot and assists the Achilles tendon in plantar flexion. The PT tendon is a stance phase muscle, firing from heel strike to shortly after heel lift-off. It decelerates subtalar joint pronation after heel contact. It functions as a powerful subtalar joint supinator and as a support of the medial longitudinal arch. The action of the tendon travels to the transverse tarsal joints, locking them and allowing the gastrocnemius to support heel rise. Acute injuries of the PT tendon are rare and mostly affect the active middle-aged patient or they are the result of complex injuries to the ankle joint complex. Dysfunction of the PT tendon following degeneration and rupture, in contrast, has shown an increasing incidence in recent years. To which extent changed lifestyle, advancing age, comorbidities, and obesity play a role has not yet been clarified in detail. Dysfunction of the PT tendon results in progressive destabilization of the hind- and midfoot. Clinically, the ongoing deformation of the foot can be classified into four stages: in stage 1, the deformity is distinct and fully correctable; in stage II, the deformity is obvious, but still correctable; in stage III, the deformity has become stiff; and in stage IV, the ankle joint is also involved in the deformity. Treatment modalities depend on stage: while conservative measures may work in stage I, surgical treatment is mandatory for the later stages. Reconstructive surgery is advised in stage II, whereas in stage III and IV correcting and stabilizing arthrodeses are advised. A promising treatment option for stage IV may be adding an ankle prosthesis to a triple arthrodesis, as long as the remaining competence of the deltoid ligament is sufficient. An appropriate treatment is mandatory to avoid further destabilization and deformation of the foot. Failures of treatment result mostly from underestimation of the problem or insufficient treatment of existing instability and deformity.
胫后（PT）肌腱的功能是稳定后足，抵抗外翻和外旋力。它是足部主要的内翻肌，并协助跟腱进行跖屈。PT肌腱是一种支撑期肌肉，从足跟触地到足跟抬起后不久都处于活动状态。足跟接触后，它会减缓距下关节的旋前。它作为强大的距下关节旋后肌，支撑内侧纵弓。肌腱的作用延伸至横跗关节，锁定关节并使腓肠肌能够支撑足跟抬起。PT肌腱的急性损伤较为罕见，主要影响活动量较大的中年患者，或者是踝关节复合体复杂损伤的结果。相比之下，近年来，PT肌腱退变和断裂后的功能障碍发病率呈上升趋势。生活方式改变、年龄增长、合并症和肥胖在其中所起的作用尚未完全明确。PT肌腱功能障碍会导致后足和中足逐渐失稳。临床上，足部的持续变形可分为四个阶段：在第一阶段，畸形明显且完全可纠正；在第二阶段，畸形明显但仍可纠正；在第三阶段，畸形已变得僵硬；在第四阶段，踝关节也参与到畸形中。治疗方式取决于阶段：保守措施可能对第一阶段有效，而后期则必须进行手术治疗。建议在第二阶段进行重建手术，而在第三和第四阶段则建议进行矫正和稳定关节融合术。对于第四阶段，只要三角韧带的剩余功能足够，一种有前景的治疗选择可能是在三关节融合术上加用踝关节假体。必须采取适当的治疗措施以避免足部进一步失稳和变形。治疗失败大多是由于对问题估计不足或对现有不稳定和畸形治疗不充分。
