Posterior Tibial Tendon Dislocation Associated with Achilles Tendon Rupture: A Case Report

Abstract

Introduction: Posterior tibial tendon dislocation is an uncommon injury. This pathology is believed to develop from an involuntary, forceful contraction of the posterior tibial muscle triggered by forced ankle inversion combined with sudden dorsiflexion. It is often accompanied by other ankle traumas that obscure its diagnosis. This report describes a rare case of concurrent posterior tibial tendon dislocation and Achilles tendon rupture in a 37-year-old male, injured during a soccer match. Methods: Initial examination confirmed a complete Achilles tendon rupture but overlooked medial ankle pain and edema. Magnetic resonance imaging revealed posterior tibial tendon dislocation with flexor retinaculum detachment and an Achilles tendon rupture located 5.5 cm proximal to its calcaneal insertion. Surgical intervention was performed in a single session, addressing both injuries. The posterior tibial tendon dislocation was corrected through a medial approach, with tendon reduction into its retromalleolar groove and flexor retinaculum reattachment to the medial tibia using transosseous sutures. Results: Achilles tendon repair was achieved using a minimally invasive Dresden technique. Postoperative rehabilitation included progressive weight-bearing, mobility exercises, and strengthening protocols, tailored to manage both injuries concurrently. By the seventh postoperative month, the patient demonstrated full recovery, with restored tendon stability, no pain or edema, and a return to pre-injury sports activities. Conclusion: This is the second reported case of concurrent Achilles tendon rupture and posterior tibial tendon dislocation and the first to propose a comprehensive surgical strategy addressing both conditions simultaneously. Early recognition and tailored surgical planning are critical to prevent chronic complications and restore functional outcomes in these rare cases.