Tibial posterior tendon dislocation associated to a lateral ligamentar lesion: case report

Abstract

Tibial posterior tendon dislocation is rare compared with other injuries. Tendon dislocation associated with lateral ligament lesion of the ankle is even rarer and difficult to establish as the primary diagnosis, because of alterations in the sprained ankle. We report a case of trauma in the left ankle with probable ankle sprain after a motorcycle accident. The patient was treated in an emergency unit, and no abnormalities were found on radiography. The patient was referred to an ambulatory unit because of foot cellulitis, which was treated. We requested other radiographs and a nuclear resonance tests because the ankle presented medial and lateral swelling and pain at palpation at the medial and lateral structures. The diagnoses were lateral ligament lesion, cuboid fracture and dislocation of posterior tibial tendon. The patient underwent surgery of the lateral and medial compartment. An immobilization boot with plantar flexion of 30° was used for 4 weeks, followed by progressive posterior elevation of the foot to 90°. Partial load bearing was authorized at week 6 and total load bearing was subsequently allowed. The patient gradually returned to daily activities.