Chiropractic Care for a Posterior Tibialis Tendon Tear in a Transgender Male Athlete with Gender-Affirming Hormone Therapy

Objective

The purpose of this case study was to report the management of a patient with posterior tibialis tendon injury concurrent with gender-affirming hormone therapy (GAHT).

Clinical Features

A 31-year-old transgender male presented to a chiropractic clinic with spontaneous, right medial foot pain following running that day. Medical history revealed bilateral congenital pes planus and intramuscular administration of testosterone for 8 years. Physical examination revealed swelling and tenderness around the medial and lateral malleoli and anterior ankle and along the medial longitudinal arch. Plantarflexion and dorsiflexion strength measured 4 out of 5. An 8 out of 10 pain level affected weight-bearing activities and sleep. Lower extremity functional scale measured 81% disability. Multimodal imaging was used in the patient's workup. Diagnostic ultrasound revealed a grade 2 tear of the posterior tibialis tendon adjacent to the medial malleolus along with additional sites of tendinosis. Referral to orthopedist and subsequent magnetic resonance imaging of the right foot and ankle confirmed the diagnosis of grade 2 tear in the posterior tibialis tendon.

Intervention and Outcome

The patient elected chiropractic care following the surgical recommendation. Nonpharmacologic management included neuromuscular re-education using whole body vibration therapy, therapeutic exercise, and ankle mortise joint mobilizations. The patient's clinical status improved, and the lower extremity functional scale measured 27% disability.

Conclusion

Although the patient was 31 years old, GAHT is recognized as a risk factor for tendinosis in older adults. An improved understanding of the correlation between tendinosis and GAHT could optimize patient outcomes and clarify the role of musculoskeletal rehabilitation for treatment.