posterior tibial tendon dysfunction

posterior tibial tendon dysfunction

; PTTD; posterior tibial tendinitis progressive degeneration of posterior tibial tendon; see compromise of tibialis posterior muscle

• causes of PTTD pathomechanical conditions of lower limb, e.g. excessive pronation, intrinsic tendon fault, direct tendon trauma, inflammatory joint disease, infection or secondary to local steroid injection

• characteristics of PTTD Table P6

• presentation of PTTD unilateral abducted flat foot, with pain distal to medial aspect of ankle (especially on joint inversion against resistance) and valgus heel on single-leg toe rise (Table 1)

• treatment of PTTD early PTTD: physical therapies (RICE(P); non-steroidal anti-inflammatory drugs, immobilization, with biomechanical gait analysis and provision of bespoke antipronatory orthoses); late-stage or recalcitrant PTTD: non-weight-bearing rigid below-knee cast or use of an ankle-foot orthosis; severe cases: surgery, e.g. debridement of hypertrophied tendon synovium, tendon repair, enlargement of its osseous groove, Kidner procedure, transfer of flexor digitorum longus tendon, triple arthrodesis

• visualization of PTTD by ultrasonography, tenography, computed tomography (CT) or magnetic resonance imaging (MRI)

  posteroanterior direction of movement or direction through a body part, from posterior toward anterior part

Table 1: Classification of posterior tibial tendon dysfunction

Stage	Clinical characteristics
1	Minimal deformity and mild weakness Chronic medial ankle pain and swelling PTT is of normal length; single-leg heel raise can be performed Local inflammation and peritendinitis or tendinosis
2	Deformities include abduction and pronation at the midtarsal joint, compensatory forefoot varus and flattening of the longitudinal axis of the medial longitudinal arch (MLA) PTT undergoes elongation Hindfoot articulations are normal Progressive inflammation and tendon degeneration
3	Rigid hindfoot and forefoot deformity: eversion of the hindfoot and abduction of the forefoot and marked flattening of the MLA
4	Valgus angulation of the talus and degeneration of the ankle joint