(Foot Health Facts 2009)
The posterior tibial tendon is one of the major supporting structures of the foot originating in the calf, running behind your ankle and inserting into the navicular on the inside of your arch. This tendon acts to hold up the medial longitudinal arch and help stabilize the foot ready for toe-off. The Tibialis Posterior muscle acts to invert and plantar flex the foot (American Academy of Orthopaedic Surgeons 2002).
Tibialis posterior dysfunction is a well-known condition among practitioners characterized by a progressive increase in tendon length impairing its ability to support and stabilize the foot (Neville C, Flemister A, Tome J, Houck JR., 2007). This increase in tendon length can be a result of an injury, increase in weight, age (particularly women over 40) and poor foot posture (Kohls-Gatzoulis, et al. 2004). Symptoms include pain around the ankle and insertion point in the arch, swelling and a visible flattening of the arch. As the condition progresses arthritis can develop in the foot and in severe cases in the ankle (Foot Health Facts, 2009).
Tibialis posterior dysfunction is often misdiagnosed in its early stages of tendonitis (tendon inflammation) and tendinosis (tendon degeneration) with health practitioners suggesting an ankle sprain as cause of pain rather than the tibialis posterior tendon (Kohls-Gatzoulis, et al. 2004). This delayed diagnosis can negatively affect treatment outcomes and quality of life. Treatment is aimed at restoring function and alleviating pain to allow return to previous activity levels.
Conservative treatment options generally involve custom foot orthotics with arch support and medial hind-foot wedging to correct foot posture. In severe cases when osteoarthritis is present and the foot is not fully correctable Ankle Foot Orthotics are required to prevent further progression and reduce pain. An AFO is often a last resort before surgery.
American Academy of Orthopaedic Surgeons 2002, Posterior Tibial Tendon Dysfunction, viewed 28 August 2011, <http://orthoinfo.aaos.org/topic.cfm?topic=a00166>.
Foot Health Facts 2009, Posterior Tibial Tendon Dysfunction, viewed 28 August 2011, <http://www.foothealthfacts.org/footankleinfo/pttd.htm>
Neville, C., Flemister, A., Tome, J., Houck, JR., 2007, ‘Comparison of Changes in Porsterior Tibialis Muscles Length Between Subjects with Posterior Tibial Tendon Dysfunction and Health Controls During Walking’, The Journal of Orthopaedic and Sports Physiotherapy, vol. 37, no.11, pp. 661-669.
Kohls-Gatzoulis, J., Angel, J C., Singh, D., Haddad, F., Livingstone, J., Berry, G 2004, ‘Tibialis posterior dysfunction: a common and treatable cause of adult acquired flatfoot,’ British Medical Journal, vol. 329, pp. 1328-33
