Abstract
Introduction: Tibialis posterior tendon dysfunction presents one of the most challenging problems that a foot and ankle specialist faces. This case report represents a very unusual presentation of retained thorn in the tendon of tibialis posterior with its management. Case presentation: A sixteen years old boy presented with H/O thorn prick injury to left ankle joint on medial side 3 months back while playing. He complain of pain and swelling on medial side of left ankle joint. He was treated at local hospital but pain and swelling partially subsided for initial 4 weeks. Then gradually pain and swelling increases over a period of 3 months. Patient was investigated (X-rays, CT Scan, MRI left ankle joint) and diagnosed as Tibialis Posterior Tenosinovitis following retained 1.5cm long thorn piercing the tendon. Surgically retained thorn was removed. Rice bodies removed from the tendon sheath found to be non tuberculous. Discussion: Tibialis posterior tenosinovitis along with rice body formation due to retained thorn following thorn prick injury is a very rare case. Mechanical irritation leading to chronic sinovitis due to thorn was responsible for the tibialis posterior tenosinovitis and non tuberculous rice body formation. In this case, surgically removing the thorn made patient symptom free and no recurrence till 5 years followup. Conclusion: Posterior tibial tendon tenosynovitis is now a recognized entity no longer confused with chronic ankle sprain or other foot / ankle disorders. Careful examination and investigation is necessary to differentiate these condition and provide appropriate treatment Keywords: Tibialis Posterior, tenosinovitis, rice body
Highlights
Tibialis posterior tendon dysfunction presents one of the most challenging problems that a foot and ankle specialist faces
None of case of tibialis posterior tenosinovitis with non tuberculous rice body formation was reported with thorn prick injury followed by retained thorn piercing the tibialis posterior tendon in the literature
Case Presentation: A sixteenyears old boy presented to orthopedics out patient department after 3 months of thorn prick injury to left ankle joint on his medial side
Summary
Tibialis posterior tendon dysfunction presents one of the most challenging problems that a foot and ankle specialist faces[1]. None of case of tibialis posterior tenosinovitis with non tuberculous rice body formation was reported with thorn prick injury followed by retained thorn piercing the tibialis posterior tendon in the literature. The patient and his father were informed that information regarding this case would be submitted for publication, and consent from father was taken. A sixteenyears old boy presented to orthopedics out patient department after 3 months of thorn prick injury to left ankle joint on his medial side. 3).CT Scan (Fig. 4) shows linear hyperdense foreign body ~ 15x2mm noted in the deep plane on the medial aspect of the ankle joint piercing the tendon of tibialis posterior.
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