Posterior Dysfunction
 


POSTERIOR TIBIAL TENDON DYSFUNCTION
(ADULT FLAT FOOT WITH DEFORMITY)

By:  Robert H. Sheinberg, D.P.M., D.A.B.F.A.S., F.A.C.F.A.S.

Progressive lowering of the arch secondary to weakness or tearing of the tendons and ligaments that support it.

CAUSE:

  • Inflammation of a tendon on the inside of the ankle and foot.
  • Weakening of the ligaments supporting the arch.
  • Connective tissue disease (i.e. rheumatoid arthritis, psoriatic arthritis).
  • Trauma to the foot or ankle (inner ankle sprain).
  • Flatfoot deformity that progresses with time.

SIGNS:

  • Swelling inside the ankle and foot.
  • Lowering or flattening of the arch (flatfoot).
  • Bulging of the bones on the inside of the ankle and foot.
  • Foot points excessively to the outside and starts to deform.

SYMPTOMS:

  • Pain with walking even short distances.
  • Stiffness of the foot and ankle that does not resolve.
  • Weakness of the muscles and ligaments supporting the arch.

ASSOCIATED PROBLEMS:

  • Bunions, hammertoes.
  • Back pain and knee pain.
  • Tight Achilles tendon.
  • Diabetes, hypertension and obesity.

TREATMENT:

  • Supporting the foot and ankle with braces and orthotics (custom shoe insoles).
  • Immobilization in a cast or boot to allow the tendon and ligaments to heal.
  • Physical therapy to improve muscle strength, flexibility and overall balance.
  • Anti-inflammatories to decrease inflammation.
  • Surgery to reconstruct the arch and prevent further damage if the condition has not improved.

PROGNOSIS:

  • If treated early, the deformity and its progression can be minimized.
  • In more moderate cases surgical stabilization of the foot will allow a return to activities.
  • In severe cases surgical reconstruction of the arch will allow the person to return to many activities. 

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The images below show intra-operative photographs of a posterior tibial tendon that does not appear healthy. There are split tears in the tendon along with color changes that indicate long term disease (left). Reflecting the posterior tibial tendon reveals the flexor hallucis longus tendon (FHL) which will be used to augment the dysfunctioning posterior tibial tendon (right). The tendons are anastamosed together using sutures so that they work together during activity (bottom).
 
 
 
 

Pics and X-rays of End Stage Adult Acquired Flatfoot after PT rupture 7 years ago.

Due to the severity of the foot collapse, the ankle joint is beginning to tilt (ankle valgus).

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