Posterior Tibial Tendon Dysfunction
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Clinically Relevant Anatomy
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The posterior tibial tendon runs posterior to the medial malleolus inserting into the navicular tuberosity and the plantar aspect of the tarsus. It is the primary stabilizer of the medial longitudinal arch, aiding in mid and hind foot locking during ambulation. If compromised, a resulting pes planus foot may develop and place greater stress on the surrounding ligaments and soft tissue. 1
Mechanism of Injury / Pathological Process
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Once thought to be a tendonitis, it is now commonly accepted the process is one of tendon degeneration or tendinosis. A poor blood supply has been identified as well as mechanical factors such as peroneal brevis overactivity or a pes planus foot. The later will gradually place increased stress to the posterior tibial tendon causing early degeneration. Trauma ( ankle sprain, fracture) may also can initiate the process. 1
Clinical Presentation[edit | edit source]
1. Pain/swelling behind medial malleolus and along medial longitudinal arch
2. Change in static/dynamic foot ( pes planus)
3. Limited walking ability
4. Impaired balance
5. Impaired MMT PF/IV
6. Difficulty/inability to perform unilateral heel raise. Limited calcaneal inversion upon ascent
7. Impaired subtalar mobility
Diagnostic Procedures[edit | edit source]
The diagnosis of posterior tibial tendon dysfunction can be made clinically based on history and objective testing. Radiographs may be beneficial for assessing degree of deformity and degenerative changes, if present. 1
Outcome Measures[edit | edit source]
Foot Functional Index (FFI) 2
Interventions
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The key to a successful outcome is early detection of the dysfunction. Orthoses use, static stretching of gastocnemius and soleus muscle, and concentric/eccentric training of the posterior tibialis have demonstrated success. As per Kulig et al, orthoses use and eccentric training demonstrate the most improvement over a 12 week period. 2
Differential Diagnosis
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1. Rupture of spring ligament 5
2. Arthritic changes in talonavicular joint 5
3. Posttraumatic tarsometatarsal joint arthritis 5
4. Inflammatory arthritis of hindfoot 5
5. Peripheral neuropathy 5
References[edit | edit source]
1. Kohls-Gatzoulis J, Angel JC, Singh D, Haddad F, Livingstone J, Berry G. Tibialis posterior dysfunction: a common and treatable cause of adult acquired flatfoot. BMJ.2004;329:1328-1333.
2. Kulig K, Reischi SF, Pomrantz AB, et al. Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise: a randomized controlled trial. Phys Ther.2009;89:26-37.
3. Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthop Rel Res.1989;239:196-206.
4. Myerson MS. Adult acquired flat foot deformity. J Bone Joint Surg.1996;45A:780-92
5. Geideman WM, Johnson JE. Posterior tibial tendon dysfunction. JOSPT.2000;30:68-77
Resources
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Case Studies[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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