Tendon and ligament injuries
Changes and injuries to the Achilles tendon, peroneal tendons and the tendon of the posterior tibialis muscle are common causes of complaints in my patients. In most cases, tendon problems can be reliably diagnosed through a thorough clinical examination. If necessary, a magnetic resonance imaging (MRI) scan can provide additional information on the extent of the change or injury.
If there is no relevant tear formation and the muscle function is not impaired despite the tendon alteration, conservative - i.e. non-surgical - treatment can often be carried out successfully. If this does not bring the desired success, surgical treatment is also possible and promising in many cases.
Ligament injuries to the ankle and foot can usually be treated conservatively with a stabilising splint. The decisive factor here is a precise assessment of which ligament structures are affected. Particularly in the case of injuries to the ankle fork (syndesmosis) or the medial ligament (deltoid ligament), a differentiated and careful diagnosis is required, as an unrecognised or inadequately treated injury in these areas can lead to permanent complaints that are difficult to treat later on.
I have been working intensively on tendon and ligament injuries for many years and have published several articles on the subject in specialist books and scientific journals. In my practice, I offer the entire surgical spectrum in the area of the foot and ankle - including complex revision procedures after previous operations in which tendons or ligaments need to be corrected or reconstructed.
Leumann A, Merian M, Valderrabano V
Ossification in chronic Achilles tendinosis: a third calf bone.
Orthopaedics. 2008; 37:481-484.
DOI: 10.1007/s00132-008-1222-8
Merian M, Wirz D, Goepfert B, Hintermann B
Neither inversion nor eversion locks the midtarsal joint: a biomechanical evaluation.
American Orthopaedic Foot and Ankle Society, 24th Annual Summer Meeting. Final Programme. 2008; 24:175-176.
Vinson EN, Dodd LG, Merian M, Martinez S
Synovial lipomatosis arborescens of the peroneal tendon sheath.
Skeletal Radiol. 2008; 37:947-950.
DOI: 10.1007/s00256-008-0558-9
Easley ME, Merian-Genast M, Assal M
Mini-Open Achilles Tendon Repair: Perspective 2.
In: Operative Techniques: Foot and Ankle Surgery. Elsevier; 2010:900-906.
DOI: 10.1016/B978-1-4160-3280-9.50059-0
Merian-Genast M, DeOrio JK, Easley ME.
Chronic Peroneal Tendon Subluxation-Dislocation.
In: Operative Techniques: Foot and Ankle Surgery. Elsevier; 2010:689-698.
DOI: 10.1016/B978-1-4160-3280-9.50059-0
A common pathological change is longitudinal tearing of the short peroneal tendon (Figure 1). As the long peroneal tendon runs directly behind the short tendon, it repeatedly slides into the cracked area when the forefoot is loaded. This prevents spontaneous healing, meaning that the longitudinal tear persists without surgical treatment (Figure 2) and the symptoms can become chronic.
Figure 1: A common pathological change is longitudinal tearing of the short peroneal tendon. In the illustration, the tear is unfolded with tweezers and appears as a clearly visible split within the tendon. This tear typically leads to pain behind the outer ankle.
Figure 2: As part of the surgical treatment, the short peroneal tendon is reconstructed into a stable tendon cord to prevent the long peroneal tendon from acting on the damaged area again. The forceps lift the reconstructed short peroneal tendon completely and show its restored continuity and stability