ABSTRACT
CONTENTS I. Introduction ................................................................................................................... 310 II. Anterior Tibial Tendon .................................................................................................. 310
A. Etiology of Rupture ................................................................................................ 311
B. Nonoperative Treatment......................................................................................... 311
C. Operative Treatment ............................................................................................... 313 III. EHL Tendon .................................................................................................................. 313
A. Etiology of Rupture ................................................................................................ 313
B. Nonoperative Treatment......................................................................................... 313
C. Operative Treatment ............................................................................................... 316 IV. EDL Tendon .................................................................................................................. 317
A. Ruptures of the EDL .............................................................................................. 317 V. Achilles Tendon.............................................................................................................. 317
A. Prerupture Conditions and Treatment .................................................................... 318
1. Nonoperative Treatment .................................................................................. 318
2. Operative Treatment......................................................................................... 319
B. Achilles Tendon Rupture ........................................................................................ 321
1. Conservative Treatment ................................................................................... 322
2. Comparison of Operative and Nonoperative Treatment .................................. 322
3. Operative Treatment......................................................................................... 323
4. Percutaneous Repair......................................................................................... 323
C. Chronic Rupture ..................................................................................................... 323
1. Operative Treatment......................................................................................... 325 VI. Peroneals ........................................................................................................................ 328
A. Anatomy ................................................................................................................. 328
B. Peroneal Tenosynovitis, Attritional Tears, and Rupture ........................................ 328
C. Peroneus Brevis Tears ............................................................................................. 329
D. Os Perineum and Peroneus Longus Tears............................................................... 329
E. Peroneus Brevis Subluxation or Dislocation........................................................... 331
F. Chronic Repairs ...................................................................................................... 333 VII. Flexor Digitorum Longus............................................................................................... 336 VIII. Flexor Hallucis Longus .................................................................................................. 336
A. Etiology................................................................................................................... 337
B. Nonoperative Treatment......................................................................................... 337
C. Operative Treatment ............................................................................................... 337 IX. Posterior Tibial Tendon.................................................................................................. 338
A. Etiology................................................................................................................... 338
B. Nonoperative Treatment......................................................................................... 339
C. Operative Treatment ............................................................................................... 339
D. Dislocation of the Posterior Tibial Tendon ............................................................ 340 X. Conclusion...................................................................................................................... 341
References .................................................................................................................................. 341
I. INTRODUCTION
Tendon ruptures and lacerations are common conditions affecting the foot and ankle. Understanding the normal function of intact tendons is helpful in appreciating the deficits of impaired tendons. Acute injuries are often responsible for the patient’s deterioration, but it is important to realize that there may be underlying preexisting tendon degeneration or abnormal mechanics that predispose the patient to acute injury. These conditions must be taken into consideration when addressing the patient surgically. In this chapter we discuss the anterior tibial tendon (ATT), extensor hallucis longus (EHL) tendon, extensor digitorum longus (EDL) tendon, Achilles tendon, peroneal tendons, flexor digitorum longus (FDL) tendon, and flexor hallucis longus (FHL) tendon, including laceration, acute rupture, degenerative rupture, and subluxation or dislocation. We present a variety of surgical techniques including debridement, repairs, reconstructions, and tendon transfers for the most common conditions encountered.
