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Acute flexor hallucis longus and fibular tendinopathies during sport activities. MRI findings and clinical impact in a prospective study

Douleur aiguë du long fléchisseur de l’hallux et tendinopathies du péroné pendant les activités sportives. Résultats d’examens IRM et impact clinique d’une étude prospective

Médecine et Chirurgie du Pied

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Abstract

Objectives

To evaluate, with magnetic resonance imaging (MRI), the occurrence of acute tendinopathy in athletes with ankle trauma during sports activities having normal radiographs and referred to the orthopedic department as “ankle sprains”.

Methods

This is a prospective study of 54 patients. Clinical examination and MR imaging were done in order to have an accurate diagnosis and point out the incidence of bone, ligament and tendon injuries.

Results

Nearly half of the patients were found to have no ligament injury on MRI. Out of 20 (37%) acute tendon injuries, nine (45%, 16.5% overall injuries) concerned the Flexor Hallucis Longus (FHL) tendon and eight (40%, 14.8% overall injuries) the fibular tendons.

Conclusions

This study reveals that acute tendon injuries and are not infrequent in “benign” ankle trauma. MRI findings were the basis for a case by case and patient centered management. Conservative treatment was effective in all patients but one who was operated on. Surgical treatment is indicated mainly for complete tendon tears.

Résumé

Objectifs

Évaluer, grâce à l’imagerie par résonance magnétique (IRM), l’apparition de tendinopathie aiguë chez les athlètes souffrant d’un traumatisme à la cheville pendant les activités sportives, dont les radiographies sont normales, et qui sont adressés au service orthopédique pour une « entorse de la cheville ».

Méthode

Cette étude prospective porte sur 54 patients. Il a été procédé à des examens cliniques et IRM afin d’obtenir un diagnostic précis et de souligner l’incidence des lésions sur les os, les ligaments et les tendons.

Résultats

Pour près de la moitié des patients, l’IRM ne présente aucune lésion des ligaments. Sur 20 (37 %) lésions aiguës des tendons, neuf (45 %, 16,5 % du total des lésions) concernent le long fléchisseur de l’hallux (FHL) et huit (40 %, 14,8 % du total des lésions) concernent les tendons péronniers.

Conclusions

Cette étude révèle que les tendinopathies aiguës ne sont pas rares parmi les cas de traumatisme « bénin » de la cheville. Les examens IRM permettent une prise en charge des patients au cas par cas et centralisée. Le traitement conservateur s’est révélé efficace pour tous les patients, à l’exception d’un seul qui a été opéré. L’intervention chirurgicale est indiquée en cas de rupture complète du tendon.

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References

  1. Schneck CD, Mesgarzadeh M, Bonakdarpour A, Ross GJ (1992) MR imaging of the most commonly injured ankle ligaments. Part 1. Normal Anatomy. Radiology 184:499–506

    PubMed  CAS  Google Scholar 

  2. Schneck CD, Mesgarzadeh M, Bonakdarpour A, Ross GJ (1992) MR imaging of the most commonly injured ankle ligaments. Part II. Ligament injuries. Radiology 184:507–512

    PubMed  CAS  Google Scholar 

  3. Kerr R, Forrester DM, Kingston S (1990) Magnetic resonance imaging of foot and ankle trauma. Orthop Clin North Am 21:591–601

    PubMed  CAS  Google Scholar 

  4. Narvaez JA, Cerezal L, Narvaez J (2003) MRI of sports-related injuries of the foot and ankle: part 1. Curr Probl Diagn Radiol 32:139–155

    Article  PubMed  Google Scholar 

  5. Campbell SE, Warner M (2008) MR imaging of ankle inversion injuries. Magn Reson Imaging Clin N Am 16:1–18,v

    Article  PubMed  Google Scholar 

  6. Breitenseher MJ (2007). Injury of the ankle joint ligaments. Radiologie 47:216–223

    Article  CAS  Google Scholar 

  7. Rijke AM, Goitz HT, McCue FC, Dee PM (1993) Magnetic resonance imaging of injury to the lateral ankle ligaments. Am J Sports Med 21:528–534

    Article  PubMed  CAS  Google Scholar 

  8. Martin B (2008) Ankle sprain complications: MRI evaluation. Clin Podiat Med Surg 25:203–247

    Article  Google Scholar 

  9. Yammine K, Fathi Y (2011) Ankle “Sprains” during sport activities with normal radiographs: incidence of associated bone and tendon injuries on MRI findings and its clinical impact. Foot (Edinb) [Epub ahead of print]

  10. Boks S, Vroegindeweij D, Koes B, et al (2006) Follow-up of occult bone lesions detected at MR imaging: systematic review. Radiology 238:853–862

    Article  PubMed  Google Scholar 

  11. Zanetti M, De Simoni C, Wetz HH, et al (1997) Magnetic resonance imaging of injurie to the ankle joint: can it predict clinical outcome? Skeletal Radiol 26:82–88

    Article  PubMed  CAS  Google Scholar 

  12. Sammarco GJ, Cooper PS (1998) Flexor hallucis longus tebdon injury in dancers and nondancers. Foot Ankle Int 19:356–362

    PubMed  CAS  Google Scholar 

  13. Trevino S, Baumhauer JF (1992) Tendon injuries of the foot and ankle. Clin Sports Med 11:727–739

    PubMed  CAS  Google Scholar 

  14. Rosenberg ZS, Beltran J, Bencardino JT (2000) From the RSNA Refresher Courses. Radiological Society of North America. MR imaging of the ankle and foot. Radiographics 20:S153–S179

    PubMed  Google Scholar 

  15. Schulhofer SD, Oloff LM (2002) Flexor hallucis longus dysfunction: an overview. Clin Podiatr Med Surg 19:411–418

    Article  PubMed  Google Scholar 

  16. Trepman E, Mizel MS, Newberg AH (1995) Partial rupture of the flexor hallucic longus tendon in a tennis player: a case report. Foot Ankle Int 16:227–231

    PubMed  CAS  Google Scholar 

  17. Scaduto AA, Cracchiolo A 3rd (2000) Lacerations and rupture of the flexor or extensor hallucis tendons. Foot Ankle Clin 5:725–736

    PubMed  CAS  Google Scholar 

  18. Holt KW, Cross MJ (1990) Isolated rupture of the flexor hallucis longus tendon. A case report. Am J Sports Med 18:645–646

    Article  PubMed  CAS  Google Scholar 

  19. Rasmussen RB, Thyssen EP (1990) Rupture of the flexor hallucis longus tendon: case report. Foot Ankle 10:288–289

    PubMed  CAS  Google Scholar 

  20. Coghlan BA, Clarke NM (1993) Traumatic rupture of the flexor hallucis longus tendon in a marathon runner. Am J Sports Med 21:617–618

    Article  PubMed  CAS  Google Scholar 

  21. Romash MM (1994) Closed rupture of the flexor hallucis longus tendon in a long distance runner: report of a case and review of the literature. Foot Ankle Int 15:433–436

    PubMed  CAS  Google Scholar 

  22. Inokuchi S, Usami N (1997) Closed complete rupture of the flexor hallucis longus tendon at the groove of the talus. Foot Ankle Int 18:47–49

    PubMed  CAS  Google Scholar 

  23. Khoury NJ, El-Koury GY, Saltzman CL, Kathol MH (1996) Peroneous longus and brevis tendon tears: MR imaging evaluation. Radiology 200:833–841

    PubMed  CAS  Google Scholar 

  24. Kuwada GT (2008) Surgical correlation of preoperative MRI findings of trauma to tendons and ligaments of the foot and ankle. J Am Podiatr Med Assoc 98:370–373

    PubMed  Google Scholar 

  25. Knupp M, Hintermann B (2010) Treatment of acute and chronic peroneal tendon disorders. Orthopade Nov 6. [Epub ahead of print]

  26. Cerrato RA, Myerson MS (2009) Peroneal tendon tears, surgical management and its complications. Foot Ankle Clin 14:299–312

    Article  PubMed  Google Scholar 

  27. Philbin TM, Landis GS, Smith B (2009) Peroneal tendon injuries. J Am Acad Orthop Surg 17:306–317

    PubMed  Google Scholar 

  28. Slater HK (2007) Acute peroneal tendon tears. Foot Ankle Clin 12:659–674

    Article  PubMed  CAS  Google Scholar 

  29. Marcus RE, Goodfellow DB, Pfister ME (1995) The difficult diagnosis of posterior tibialis tendon rupture in sports injuries. Orthopedics 18:715–721

    PubMed  CAS  Google Scholar 

  30. Marcus RE, Pfister ME (1993) The enigmatic diagnosis of posterior tibialis tendon rupture. Iowa Orthop J 13:171–177

    PubMed  CAS  Google Scholar 

  31. Foster AP, Thompson NW, Crone MD, Charlwood AP (2005) Rupture of the tibialis posterior tendon: an important differential in the assessment of ankle injuries. Emerg Med J 22:915–916

    Article  PubMed  CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. The Foot and Hand Clinic, Emirates Hospital, Dubai, UAE

    K. Yammine

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  1. K. Yammine
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Correspondence to K. Yammine.

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Yammine, K. Acute flexor hallucis longus and fibular tendinopathies during sport activities. MRI findings and clinical impact in a prospective study. Med Chir Pied 27, 93–96 (2011). https://doi.org/10.1007/s10243-011-0320-1

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  • DOI: https://doi.org/10.1007/s10243-011-0320-1

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