What is the treatment for a ruptured tibial tendon?

Treatment for Ruptured Tibial Tendon

For ruptured tibial tendon, surgical repair is recommended, particularly for young active patients with high functional demands, while nonsurgical management may be appropriate for elderly patients with low functional demands. 1

Diagnosis

• Clinical diagnosis can be established using two or more of the following tests:
  • Thompson/Simonds squeeze test
  • Decreased ankle plantar flexion strength
  • Presence of a palpable gap
  • Increased passive ankle dorsiflexion 2
• Main symptoms include inability to dorsiflex the foot and a palpable gap 3
• Diagnosis can be confirmed by sonography or MRI, though routine imaging is not always necessary when clinical diagnosis is clear 3, 2

Treatment Options

Surgical Treatment

• Surgical repair is indicated for:
  • Young, active patients with high functional demands 1
  • Both acute and chronic ruptures 4
  • Complete ruptures with significant functional deficit 4

Surgical Techniques:

• Direct tendon repair when possible 4
• Interpositional autogenous tendon graft for more complex or chronic cases 4
• Distal refixation when rupture occurs at insertion point 3

Post-Surgical Management:

• Immobilization options include:
  • Cast boot for 6 weeks 3, 5
  • External fixation for patients with high risk of cutaneous complications 5
  • Protective device that limits dorsiflexion to prevent compromise of the repair 2
• Early (≤2 weeks) protected weight bearing is suggested 2
• Return to sports may be possible within 3-6 months after surgical treatment 2

Nonsurgical Treatment

• May be appropriate for:
  • Elderly patients with low functional demands 1
  • Patients with significant medical comorbidities 1

Outcomes

• Surgical repair shows significant improvement in function:
  • Average American Orthopaedic Foot and Ankle Society hindfoot score improvement from 55.5 to 93.6 points 4
  • Recovery of functional dorsiflexion and gait improvement in 95% of cases 4
  • Full ankle dorsiflexion strength (5/5) in approximately 79% of cases 4

Important Considerations

• Early surgical treatment may be less complicated than delayed treatment 4
• Patient compliance with postoperative protocols is crucial to prevent rerupture 2
• Complications requiring secondary procedures may occur in approximately 16% of cases 4
• For posterior tibial tendon ruptures specifically, surgery may restore function but not necessarily the flattened longitudinal arch 6

Rehabilitation

• Mobilization by 2-4 weeks postoperatively using a protective device is recommended 2
• While specific physical therapy protocols lack strong evidence, rehabilitation is generally indicated following immobilization 2