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Rate ePoster

Musculoskeletal and Sports Medicine

Active-duty service member with Tibialis Anterior Tendinopathy & Impingement following Lapidus Bunionectomy: A Case Report

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks
Has Audio

    Poster Presenter(s)

  • Ervin Anies, MD

    Battalion Surgeon
    2d Battalion, 4th Marines
    San Clemente, California

    • Co-Author(s)

  • ES

    Eric Super, MD

    Brigade Surgeon
    United States Army
    Aberdeen, North Carolina

  • SL

    Sean A. Lacey, DO

    Department Head Orthopedics and Sports Medicine, U.S. Naval Academy
    US Navy
    Arnold, Maryland

Disclosure(s):
Ervin Anies, MD: No financial relationships to disclose
Case Diagnosis: Tibialis anterior tendinopathy and impingement following Lapidus Bunionectomy.

Case Description or Program Description: A 24-year-old active-duty female with history of a bilateral pes planus and Lapidus Bunionectomy was referred to Physical Medicine & Rehabilitation (PM&R) for chronic foot pain. Her pain and swelling were along the anteromedial aspect of her midfoot near the Tibialis Anterior (TA) insertion site and exacerbated by running. Her symptoms remained refractory following six months of physical therapy and significantly limited her ability to run longer than 1 mile. The patient’s corresponding Magnetic Resonance Imaging (MRI) demonstrated no structural explanation and lacked evidence of TA tendonitis.

Setting: Outpatient rehabilitation electrodiagnostic, ultrasound, sports medicine clinic.

Assessment/Results: Diagnostic ultrasound of the foot and ankle exhibited thickening of the TA tendon with increased power doppler flow adjacent to the hardware. There was a screw in close proximity to the tendon distally with increased peritendinous anechoic fluid. Sonopalpation manifested a reproduction of her symptoms and a diagnostic block to the affected region resulted in 100% pain relief, confirming the diagnosis.

Discussion (relevance): Point of care ultrasound and diagnostic blocks can enhance detection of pathology intimately involved with post-surgical hardware that may otherwise be obscured by MRI artifact. As such, tendinopathic changes affecting patients functionally, may occur at higher rates than evident on MRI alone.

Conclusions: Diagnostic ultrasound can serve to augment evaluation and treatment of tendinopathies in the presence of surgical hardware when compared to MRI alone, especially in the management of complex ankle/foot pain in an active-duty patient.