SLR - September 2022 - Samuel R. Gorelik, DPM
Reference: Tendinopathies of the Foot and Ankle. Deu RS, Coslick AM, Dreher G, Am Fam Physician.2022 May 1;105(5):479-486.Level of Evidence: Level 5
Scientific Literature Review
Reviewed by: Samuel R. Gorelik, DPM
Residency Program: Saint Vincent Hospital, Worcester, MA
Podiatric Relevance: This article was published in a journal dedicated to Family Physicians to discuss common tendinopathies of the foot and ankle, while emphasizing how they are commonly missed. They discussed the posterior tibial, peroneal, and tibialis anterior tendons. This provides an excellent summary on how to evaluate the patient along with common imaging and treatments that are required. It is important to read non-Podiatry journals as well to understand how other specialties are evaluating Podiatric issues. This will make communication between specialists more effective. The main clinical question that was being answered was how should tendinopathies of the foot and ankle, including posterior tibial, peroneal, and tibialis anterior, be properly evaluated by a family physician.
Methods: This article was describing the history and physical examination, imaging, and treatment for the tendinopathies mentioned above. This article was an expert review of how to properly diagnose and evaluate someone for those tendinopathies.
Results: The posterior tibial tendon is described as one of the major stabilizers of the medial arch of the foot. With dysfunction of the posterior tibial tendon, the development of acquired flat feet can be seen clinically. Treatments would include arch support along with physical therapy exercises. Peroneal tendinopathies are often misdiagnosed as ankle sprains. It is important to identify the course of the discomfort. With peroneal weakness, the patient will have limited eversion so the patient will present with a varus rearfoot. Immobilization, lateral posted orthotics, and physical therapy can help with this conservatively. Tibialis anterior tendinopathy presents with weakness of dorsiflexion of the ankle. Patients would present with nonspecific anterior ankle and medial midfoot pain along the tendon. Conservative therapy typically consists of immobilization followed by physical therapy.
Conclusions: When patient’s come in with foot and ankle pain, primary physicians are typically able to diagnose ankle sprains, Achilles tendinopathy, and plantar fasciitis. Often times other tendinopathies are misdiagnosed and placed under those categories. It is vital in evaluating a patient for a tendinopathy that a thorough exam is performed to identify the cause of the pain, its location, and what exacerbates the pain. These details help identify the tendon that is the root cause of the patient’s complaints. The tendon involved will have decreased strength and the patient will likely have pain along the path of that tendon. Generalized treatments for these conditions include footwear adjustments, rehabilitation, and Rest Ice Compression and Elevation protocols. Drawbacks of Non-Steroidal Anti-Inflammatories and Acetaminophen use include slowing down the recovery process despite the minimal relief in pain. Corticosteroids can also provide short-term pain relief, but it can put the tendon at increased risk of rupture. This information is important for the Podiatric phsycian to understand what basic knowledge the primary care physician may have when referring patients for more specific care and what initial treatment modalities may have been attempted.