Incidence of Midfoot Instability in Patients with Achilles Tendon Ruptures (ATR): Why ATR is a Secondary Sign of Spring Ligament Laxity
Journal Title: Journal of Orthopaedic Science and Research - Year 2025, Vol 6, Issue 1
Abstract
Achilles Tendon Rupture (ATR) is a common yet debilitating injury that affects individuals of all ages and activity levels. Several theories describe the pathogenesis of ATR. This study aims to evaluate if there is increased medial column instability in terms of talonavicular laxity or first ray instability in patients with ATR. Patients were recruited from a database of Tendoachilles (TA) ruptures presenting to the clinic. All patients underwent non operative treatment. Patients with pre-existing foot surgery, arthropathy or generalised laxity were excluded. A total of 14 TA ruptures were assessed for First Ray (FR) instability and Spring Ligament (SL) incompetence. Results: No patients had pre-existing Achilles problems or foot instability in our cohort. One patient had a chronic unilateral rupture, missed an initial presentation and had treatment. TA maximum Anteroposterior (AP) thickness between affected and unaffected feet demonstrated no significant difference. ATR feet demonstrated greater midfoot instability in terms of both Talonavicular (TN) laxity and First Ray Instability in all ATR feet (p<0.05). Despite medial column instability the incidence of significant valgus impingement pain was 8/14 cases. Both were statistically increased. This suggests that combined pathogenesis may be responsible for both pathologies. In conclusion, this is the first study to our knowledge that reports increased medial column laxity being present in all ATR feet. External biomechanical factors in a predisposed foot help generate an internal moment/ force that overloads the TA. The relationship between intrinsic foot biomechanics and ATR has not been described. Future treatments may therefore be directed at restoring midfoot stability using orthotics or surgery to help restore biomechanics and to help offload the TA and protect the foot from future re-ruptures.
Authors and Affiliations
Luisa Valentini1, Md Abdul Aziz1*, Simrin Chaudhri1, Steven O Famure1, Zhikai Li2, Chandra Pasapula1*
Keywords
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- EP ID EP758359
- DOI https://doi.org/10.46889/JOSR.2025.6105
- Views 44
- Downloads 0
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