The anatomical relationship between the tibialis posterior tendon and the talus - Dissection and osteopathic interpretation

Background: Chronic pain is more frequent in older people, and ankle pain is one of its main causes. Symptomatic tibialis posterior tendon (TPT) dysfunction, where the tendon and tendon sheath become inflamed, is a specific example of this. Aim: This study provides anatomical information on the relationship between the talus head and the TPT, or more specifically, the TPT nodule, which is no longer described in the literature. This information may help account for clinical signs, namely somatic dysfunction as defined by the acronym TART - Tenderness, Asymmetry, Restricted motion, and Tissue texture changes, detected during osteopathic examination. Methods: Fifteen non-embalmed cadaveric specimens collected during the dissection of cadavers at Paris Descartes medical university were studied. Non-embalmed cadavers were used to ensure an optimal protection of cartilage structures. The specimens were dissected following the same procedure, and by the same person (CG), professor of anatomy, between November 2008 and May 2009. Results: Examination of the TPT revealed the constant presence of a nodule next to the talus head in our fifteen specimens. Two nodules were dissected; one was found to be fibrocartilaginous and the other partly calcified. A talus classification system was devised. Two tali were found without dimple; five with shallow dimple and no cartilage destruction; and eight displayed changes in bone structure and cartilage destruction. One specimen was sectioned into 3 mm-thick slices revealing the bone structure under the cartilage precisely and signs of osteitis. Tissue damage (cartilage or bone injury) was found in half of our cadaveric specimens, suggesting that this imbalanced relationship with the talus head may result in irreversible damage. Two feet showed no signs of cartilage injury from which we conclude that the tissue damage is a deteriorative process. Discussion: Some signs of somatic dysfunction may be caused by irreversible anatomical changes, and therefore osteopathic treatment would not yield long-lasting results and loco-regional treatment would be ineffective. In such cases, osteopathy would only complement and not provide an alternative to conventional care. Osteopathy may nevertheless obtain beneficial outcomes; we know that it can improve biomechanical functions and decrease nociceptive inputs even in irreversible processes, such as spondylolisthesis. In living patients, talus deterioration may be seen using a radiological examination. Studying anatomy using dissection is potentially of great value in osteopathic diagnosis and hence to osteopathic care. Our study provides a different anatomical description to that seen in modern literature in that we found the TPT nodule to be constantly present. Our results suggest a possible evolution in the relationship between the talus head and the TPT nodule: the nodule may be exerting pressure on the cartilage, over time leading to injury, the bone structure eventually being attacked. To our knowledge research using dissection or radiological examination has not yet been carried out about the effect of a tendon nodule on bone structure. © 2013