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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