What is Posterior Tibial Tendon Dysfunction?   by Craig Payne

in Health / Diseases and Conditions    (submitted 2010-06-26)

The arch of the foot is an important structure for normal function and biomechanics. Any abnormalities with the arch of the foot predisposes the foot to a wide range of problems. The integrity and structure of the arch is maintained by numerous elements. These include the alignment and shape of the bones in the foot, the ligaments that hold the bones together, the muscles and their tendons that support the bones and ligaments, as well as other soft tissues such the plantar fascia. Probably the most important structure is a muscle in the leg, called the posterior tibial muscle. The tendon of this muscle passes down the inside of the ankle joint and inserts into the middle of the arch. Due to its position, this muscle and tendon are the primary supporter of the arch of the foot. If this muscle and tendon complex can no longer do its function of supporting the arch, posterior tibial tendon dysfunction is often the result.

In posterior tibial tendon dysfunction, the arch progressively gets flatter and the ankle rolls inwards. There is also pain on the inside of the ankle and in the arch area. Both the deformity and pain start off relatively mild, but are almost always progressive if they are not treated. The deformity can become very disabling if it is not arrested at an early stage and is allowed to progress.

The treatment for posterior tibial tendon dysfunction is the early use of rigid foot orthotics. Soft foot orthotics do not provide enough force to stop the deforming forces and will get flattened. High top, hiking like boot are also useful to stabilise the rearfoot. If this is not successful or if the deformity has progressed before treatment is started, then a brace for the rearfoot is needed. If this is not successful or if the deformity has progressed, then surgery is usually the only option.

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