Posterior Tibial Tendinopathy and Osteopenia as Primary Symptoms of Celiac Disease: A Case Report |
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| Institution: | 1. Orthopedic Surgeon, Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan;2. Orthopedic Surgeon, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD;3. Research Assistant, Orthobiologic Laboratory, MedStar Health Research Institute at MedStar Union Memorial Hospital, Baltimore, MD;4. Orthopedic Surgeon, Department of Rehabilitation, The Affiliated Hospital of Qingdao University, Shandong, P. R. China;5. Rheumatologist, Division of Rheumatology, Icahn School of Medicine at Mount Sinai, New York, NY;6. Director, Orthobiologic Laboratory, MedStar Health Research Institute at MedStar Union Memorial Hospital, Baltimore, MD;7. Director, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD;1. Assistant Professor, Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan;2. Orthopedic Surgeon, Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan;3. Professor, Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan;1. Resident, Center for Wound Healing and Hyperbaric Medicine, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC;2. Medical Student, Georgetown University School of Medicine, Washington, DC;3. Georgetown University School of Medicine, Washington, DC;4. Assistant Professor, Center for Wound Healing and Hyperbaric Medicine, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC;5. Professor, Center for Wound Healing and Hyperbaric Medicine, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC;6. Professor, Department of Plastic Surgery, University of Texas Southwestern, Dallas, TX;1. Attending Staff, Department of Orthopedic Surgery, Kaiser Permanente, San Francisco, San Francisco, CA;2. Attending Staff, Department of Podiatric Surgery, Kaiser Permanente, Oakland, Oakland, CA;3. Research Analyst, Division of Research, Kaiser Permanente, Oakland, Oakland, CA;4. Attending Staff, Kaiser Permanente, Sacramento, Sacramento, CA;5. Attending Staff, Department of Orthopedics, Division of Podiatric Surgery, Swedish Medical Center, Seattle, WA;6. Private Practice, Southern Arizona Orthopedics, Tucson, AZ;1. Fellowship Trained Foot and Ankle Surgeon and Orthopedic Fellow, Paley Orthopedic and Spine Institute, West Palm Beach, FL;2. Foot and Ankle Surgeon, Lone Star Orthopaedic and Spine Specialists, Fort Worth, TX;3. Attending Foot and Ankle Surgeon, Sanford Medical Center, Bemidji, MN;4. Associate Professor, Department of Orthopaedic Surgery, University of North Texas Health Science Center, Fort Worth, TX;5. Podiatric Residency Director, Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX;1. Fellow, American Health Network Foot and Ankle Reconstructive Surgery Fellowship, Carmel, IN;2. Surgeon, Fellowship Faculty, American Health Network, Lafayette and Kokomo, IN |
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| Abstract: | This case report describes posterior tibial tendon (PTT) tendinopathy, valgus deformity with tenosynovitis, and osteopenia at the medial malleolus as the primary symptoms of a young patient with celiac disease (CD) without gastrointestinal symptoms. CD is an autoimmune condition that is a chronic inflammatory disorder of the small intestine triggered by ingestion of gluten in individuals with a particular genetic background. Without typical gastrointestinal symptoms, CD patients are often misdiagnosed or undiagnosed. The patient was diagnosed with CD by duodenal biopsy. He underwent a surgical procedure, including medial displacement calcaneal osteotomy, tenosynovectomy of the PTT and flexor digitorum longus (FDL), FDL transfer to the navicular for a pes planovalgus deformity, and drilling of the medial malleolus for a stress reaction. The mechanism of the PTT tear and associated heel valgus deformity was assumed to be related to the fact that his heel alignment on the affected side changed gradually from normal to valgus and pes planus owing to CD and mechanical stress, because his normal-side heel alignment was neutral before surgery and at final follow-up. His operated ankle was pain-free, with full range of motion, 1.5 years after surgery. The patient was able to restart running and exercise gradually. Foot and ankle specialists should consider the possibility of CD in patients presenting with a PTT tear without injury or trauma and osteopenia with no obvious reason. |
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