Truthan Faith, Hass Noah, O'Brien Aidan, Hewitt Mark, Haun Daniel, Kettner Norman
Logan University, Chesterfield, Missouri.
J Chiropr Med. 2024 Dec;23(4):197-204. doi: 10.1016/j.jcm.2024.08.009. Epub 2024 Oct 29.
The purpose of this case study was to report the management of a patient with posterior tibialis tendon injury concurrent with gender-affirming hormone therapy (GAHT).
A 31-year-old transgender male presented to a chiropractic clinic with spontaneous, right medial foot pain following running that day. Medical history revealed bilateral congenital pes planus and intramuscular administration of testosterone for 8 years. Physical examination revealed swelling and tenderness around the medial and lateral malleoli and anterior ankle and along the medial longitudinal arch. Plantarflexion and dorsiflexion strength measured 4 out of 5. An 8 out of 10 pain level affected weight-bearing activities and sleep. Lower extremity functional scale measured 81% disability. Multimodal imaging was used in the patient's workup. Diagnostic ultrasound revealed a grade 2 tear of the posterior tibialis tendon adjacent to the medial malleolus along with additional sites of tendinosis. Referral to orthopedist and subsequent magnetic resonance imaging of the right foot and ankle confirmed the diagnosis of grade 2 tear in the posterior tibialis tendon.
The patient elected chiropractic care following the surgical recommendation. Nonpharmacologic management included neuromuscular re-education using whole body vibration therapy, therapeutic exercise, and ankle mortise joint mobilizations. The patient's clinical status improved, and the lower extremity functional scale measured 27% disability.
Although the patient was 31 years old, GAHT is recognized as a risk factor for tendinosis in older adults. An improved understanding of the correlation between tendinosis and GAHT could optimize patient outcomes and clarify the role of musculoskeletal rehabilitation for treatment.
本病例研究的目的是报告一名患有胫后肌腱损伤并同时接受性别确认激素治疗（GAHT）的患者的治疗情况。
一名31岁的跨性别男性因当天跑步后右足内侧自发疼痛就诊于一家整脊诊所。病史显示双侧先天性扁平足，已接受8年的睾酮肌肉注射。体格检查发现内外踝周围、踝关节前方以及内侧纵弓处肿胀和压痛。跖屈和背屈力量为4级（满分5级）。疼痛程度为8级（满分10级），影响负重活动和睡眠。下肢功能量表显示残疾程度为81%。对该患者进行了多模态影像学检查。诊断性超声显示在内踝附近的胫后肌腱有2级撕裂，同时存在肌腱病的其他部位。转诊至骨科医生，随后对右脚和踝关节进行磁共振成像，证实了胫后肌腱2级撕裂的诊断。
患者在接受手术建议后选择了整脊治疗。非药物治疗包括使用全身振动疗法进行神经肌肉再教育、治疗性锻炼以及踝关节榫眼关节松动术。患者的临床状况得到改善，下肢功能量表显示残疾程度为27%。
尽管患者年仅31岁，但GAHT被认为是老年人肌腱病的一个危险因素。更好地理解肌腱病与GAHT之间的相关性可以优化患者的治疗效果，并阐明肌肉骨骼康复在治疗中的作用。
