Tibialis anterior tendon rupture in gout—Case report and literature review

Jerome, J. Terrence Jose; Varghese, Mathew; Sankaran, Balu; Thomas, Simon; Thirumagal, SK

doi:10.1016/j.fas.2007.12.001

« PreviousFoot and Ankle Surgery
Volume 14, Issue 3 , Pages 166-169, 2008

Tibialis anterior tendon rupture in gout—Case report and literature review

J. Terrence Jose Jerome, MBBS, DNB (Ortho), MNAMS (Ortho) FNB (Hand & Microsurgery)
- Registrar in Orthopaedics, Department of Orthopaedics, St Stephen's Hospital, Tiz Hazari, Delhi 54, India.
- Corresponding author. Tel.: +91 1 09868086916; fax: +91 1 23932412.
Mathew Varghese, MS (Ortho)
- Head, Professor, Department of Orthopaedics, St Stephen's Hospital, Tiz Hazari, Delhi 54, India. Tel.: +91 1 23966021 27; fax: +91 1 23932412.
Balu Sankaran, FRCS (C), FAMS
- Professor Emeritus, Orthopaedics, St Stephen's Hospital, Tiz Hazari, Delhi 54, India. Tel.: +91 1 23966021 27; fax: +91 1 23932412.
Simon Thomas
- Registrar in Orthopaedics, Department of Orthopaedics, St Stephen's Hospital, Tiz Hazari, Delhi 54, India.
Thirumagal SK, MD
- Tamilnadu, India.

Department of Orthopaedics, St Stephen's Hospital, Tiz Hazari, Delhi 54, India

Received 10 December 2007; accepted 17 December 2007.

Abstract

Background

A case report in which spontaneous rupture of the tibialis anterior tendon occurred secondary to a gouty tophaceous deposit within the tendon. The injury occurs in middle-aged and elderly patients after displacement of the foot in plantar flexion and eversion. The treatment of the rupture is discussed.

Method

An appropriate clinical examination, including an exact history taking, leads to the right diagnosis of tibialis anterior tendon rupture in gout. The rupture can occur through abnormal tendons or may occur in any portion of the tendon, but causes little disability if diagnosed promptly.

Results

Repair of the tibialis anterior tendon was done by non-absorbable suture. The leg was immobilized in a plaster cast, and daily active assisted exercises were started at the end of 3 weeks. Patient retained full function, power, and range of motion in foot and ankle at the end of 6 months.

Conclusions

Closed rupture of the anterior tibial tendon is uncommon in gout, with few cases being reported previously. This report adds to the list of pathological conditions that should be considered in closed spontaneous rupture of the tibialis anterior tendon. Early repair does improve the likelihood of a good result. The problem of the contributory effect of atresia, degenerative changes, or both, has not yet been solved. Primary operative suture, preferably with non-absorbable suture is the treatment of choice for acute ruptures and for patients with high activity levels. Recovery is prompt with little, if any, measurable permanent disability.

Keywords: Tibialis anterior, Rupture, Gout, Management