Diagnosis arch hindfoot posterior tibial tendon dysfunction. Medical search. Frequent questions

Valgus angulation of the hindfoot is frequently seen with accompanying abduction of the forefoot, which is named the "too-many-toes" sign. (ankleplatform.com)
Degeneration results from long-standing biomechanical problems, such as excessive pronation (often in people with obesity), hindfoot valgus or chronic tenosynovitis. (msdmanuals.com)
The pull of the Achilles tendon is altered and creates a hindfoot valgus, which, in turn, contributes to degenerative changes at the subtalar joint and progression to arthritis. (msdmanuals.com)
In late stages, the ankle joint will undergo arthritic changes due to the hindfoot valgus deformity. (msdmanuals.com)
Pes planus/ pes planovalgus (or flat foot) is the loss of the medial longitudinal arch of the foot , heel valgus deformity, and medial talar prominence. (physio-pedia.com)
Heel eversion or hindfoot valgus is generally accepted as a normal finding in young, newly walking children and is expected to reduce with age. (physio-pedia.com)

Insufficiency or dysfunction of the posterior tibial tendon (PTT) has historically been thought to be the most common cause of AAFD. (medscape.com)
AAFD has many other names such as posterior tibial tendon dysfunction, posterior tibial tendon insufficiency, and dorsolateral peritalar subluxation. (alpineorthopedics.com)
Chronic posterior tibial tendon insufficiency can result in acquired adult flatfoot deformity. (weebly.com)
If initial conservative therapy of posterior tibial tendon insufficiency fails, surgical treatment is considered. (weebly.com)

In addition to tendons running across the ankle and foot joints, a number of ligaments span and stabilize these joints. (alpineorthopedics.com)
The ligaments at the inside of the ankle also can become stretched and contribute to the progressive flattening of the arch. (alpineorthopedics.com)
With a relatively flat arch, more stress is placed on the posterior tibial tendon and also on the ligaments on the inside of the foot and ankle. (alpineorthopedics.com)
This is a chronic foot condition where the soft-tissues (including the posterior tibial tendon, deltoid and spring ligaments) on the inside aspect of the ankle are subject to repetitive load during walking and standing. (weebly.com)
As the person with flat feet ages, the muscles, tendons and ligaments weaken. (weebly.com)
Once the posterior tibial tendon and ligaments stretch, body weight causes the bones of the arch to move out of position. (weebly.com)
These include the type of shoes a child wears [4-6], rheumatic arthritis, compensation for other abnormalities further up the leg, or more severe factors such as rupture of the ligaments or tendons in the foot [7]. (who.int)
They were given a brief general medical examination and a short questionnaire to collect data about age, residence, past history of accidents (with ruptured ligaments and/or tendons in the feet) and usual footwear during childhood. (who.int)
The ankle and foot form a complex structure of 28 bones, also known as tarsals (including two sesamoid bones) and 27 articulations (including 20 synovial joints), interconnected by more than 100 ligaments and muscles, that form 7 distinct segments: the shank, hindfoot, lateral and medial midfoot, lateral and medial forefoot, and the hallux. (mhmedical.com)

Tibialis posterior tendinosis, which is degeneration of the tibialis posterior tendon, and tibialis posterior tenosynovitis are the most common causes of pain behind the medial malleolus. (msdmanuals.com)
Tibialis posterior tendinosis and tenosynovitis are diagnosed clinically. (msdmanuals.com)
Pain and swelling with tenderness of the tibialis posterior tendon behind the medial malleolus is suggestive of tenosynovitis. (msdmanuals.com)

Distally, the retinaculum blends with the sheath of the tendon and the superficial deltoid ligament. (ankleplatform.com)
A tendon sheath surrounds the posterior tibial tendon, and both structures are connected by a vincula, which carries part of the blood supply to the tendon. (ankleplatform.com)
Tenosynovitis of the tendon sheath begins with acute inflammation. (msdmanuals.com)
Operative treatment of stage 1 disease involves release of the tendon sheath, tenosynovectomy, debridement of the tendon with excision of flap tears, and repair of longitudinal tears. (weebly.com)

This is due to damage to the posterior tibial tendon which is the main tendon supporting the arch of the foot. (footankleinstitute.com)

In the early stage of dysfunction, patients complain of persisting ankle pain medially along the course of the tendon, in addition to fatigue and aching on the plantar medial aspect of the ankle. (ankleplatform.com)

Surgical correction of hindfoot varus is frequently performed with a lateral displacement calcaneal osteotomy. (qxmd.com)
We report the first case of acute postoperative tarsal tunnel syndrome in a neurologically intact patient with post-traumatic hindfoot varus. (qxmd.com)
Failure to identify patients with paradoxical flatfeet varus may lead to an incorrect diagnosis and management. (bvsalud.org)

Furthermore, Pisani described a medial peritalar instability with posterior tibial tendon dysfunction as being both a possible cause and consequence of spring ligament injuries, referring to them as degenerative glenopathy.33 The acetabulum pedis presents a panniculus adiposus in the middle and, then, medially the bone structure with navicular posterior facet and calcaneal anterior facets. (federicousuelli.com)

The foot has both a medial and a lateral longitudinal arch. (medscape.com)
The lateral arch consists of the calcaneus, the cuboid, and the fourth and fifth metatarsals. (medscape.com)
With weightbearing, tensile forces in the plantar fascia prevent separation of the ends of the medial and lateral arches. (medscape.com)
From a diagnostic point of view, the condition may be difficult to differentiate from an avascular necrosis or even a stress fracture of the navicular, but fragmentation is the result of a mechanical impairment rather than a biological dysfunction.Standardized weight-bearing radiographs (anteroposterior and lateral views) of both feet are usually enough to diagnose MWD. (bvsalud.org)

If the tendon ruptures (eg, with chronic tendinosis), the foot may acutely flatten (arch collapse) and pain may extend into the sole. (msdmanuals.com)

The tendon forms in the distal third of the calf and passes behind the medial malleolus where it changes direction. (ankleplatform.com)
The posterior tibial tendon is the most superficial structure coursing behind the medial malleolus. (ankleplatform.com)
Pain complaints are often located in the relative hypovascular zone immediately distal to the medial malleolus, beginning 4 cm proximal to the insertion of the tendon. (ankleplatform.com)
The posterior tibial tendon is held in the retromalleolar groove by a strong fibro-osseous tunnel and the flexor retinaculum originating from the tip of the medial malleolus inserting into the calcaneus. (ankleplatform.com)
In these patients, a painful local thickening can be palpated posterior and just proximal to the tip of the medial malleolus. (ankleplatform.com)
The posterior tibial tendon lies immediately behind the medial malleolus. (msdmanuals.com)
In tenosynovitis, pain is typically more acute and the tendon may feel thick and swollen as it courses around the medial malleolus. (msdmanuals.com)

Tight Achilles tendon and/or calf muscle are also a risk factor for flat feet. (footankleinstitute.com)
Others may experience foot pain, knee pain, shin splints and pain in the achilles tendon. (who.int)
Surgery, by relieving pressure, repairing a muscle or lengthening/replacing the achilles tendon, can only benefit a patient if drop foot has been diagnosed correctly as a muscular or nerve difficulty. (kevinrootmedical.com)
The Achilles tendon is the most powerful tendon in the human body. (bone-joint.com)
Achilles tendon is the tendon that connects the heel of the foot to the heel of Glossary of medicine - the thickest tendon in the human body, located at the back of the lower leg. (w8md.com)

The anterior, major slip of the tendon inserts primarily into the tuberosity of the navicular, the inferior capsule of the medial naviculocuneiform joint and the inferior surface of the medial cuneiform. (ankleplatform.com)
Conventional radiographs may show abnormal alignment like flattening of the plantar arch or bony changes such as bony irregularity and hypertrophic change at the navicular attachment, providing an important clue to the presence of longstanding problems with the posterior tibial tendon. (ankleplatform.com)
This muscle then turns into the posterior tibial tendon, which passes behind the inside of the ankle and attaches to the navicular bone along the instep of the foot. (alpineorthopedics.com)
It is usually accepted that acquired flatfoot deformity after injury is usually due to partial or complete tear of the posterior tibial tendon (PTT), with secondary failure of the other structures which maintain the medial longitudinal arch, such as the plantar calcaneo-navicular (SPRING) ligament. (qxmd.com)

15] A widely accepted classification system, proposed by Johnson in 1989 and modified by Myerson in 1997, clarified treatment recommendations on the basis of the severity of the PTT dysfunction and the adaptation of the foot to collapse of the medial longitudinal arch. (medscape.com)
In cases of flatfoot, sinus tarsi syndrome is complicated by the collapse of the arches. (wikipedia.org)
This problem may progress from early stages with pain and swelling along the posterior tibial tendon to complete arch collapse and arthritis throughout the hindfoot (back of the foot) and ankle. (alpineorthopedics.com)
Unilateral arch collapse with medial ankle bulging and forefoot abduction (too many toes sign) is particularly suggestive of advanced tendon pathology and warrants testing for tendon rupture. (msdmanuals.com)
The one common thread running through these conditions is a partial or complete collapse of the arch of the foot. (footankleinstitute.com)
With a tear in the tendon over many years of abnormal strain, the arch will begin to collapse as the posterior tibial tendon weakens and unravels. (footankleinstitute.com)
It is important to treat a flexible flat foot due to posterior tibial tendon tear rapidly prior to the joints becoming rigid due to the severe collapse. (footankleinstitute.com)
The deformity in flexible flatfoot involves a mild, gradual collapse of the foot's arch, and almost always occurs in both feet. (footankleinstitute.com)
In the case of a flexible flat foot that is not due to a posterior tibial tendon tear, support of the arch with insoles, orthotics, and rigid-soled shoes will decrease the strain on the posterior tibial tendon and decrease the risk of further and permanent arch collapse due to tendon tear. (footankleinstitute.com)

The function and structure of the medial longitudinal arch are affected by numerous anatomic structures, all offering potential contributions to the pathophysiology of AAFD. (medscape.com)
Adult acquired flatfoot deformity (AAFD) is a progressive flattening of the arch of the foot. (alpineorthopedics.com)
Patients with AAFD often experience pain, deformity, and/or swelling at the ankle or hindfoot. (alpineorthopedics.com)
Posterior tibial tendon dysfunction is the most common cause of AAFD. (alpineorthopedics.com)
The diagnosis of posterior tibial tendon dysfunction and AAFD usually is made from a combination of symptoms, physical exam and X-rays. (alpineorthopedics.com)
There are a number of factors that can lead to adult acquired flat foot deformity (AAFD), a condition that can leave the patient with a fallen arch and the foot pointed outward. (fireflyorthoses.com)

The posterior tibial muscle arises from the interosseous membrane and the proximal adjacent surfaces of the tibia and fibula and is part of the deep posterior compartment of the calf. (ankleplatform.com)
The posterior tibial muscle originates on the bones of the lower leg (tibia and fibula). (alpineorthopedics.com)

In this system, the superficial branch of the deltoid ligament and the insertional portion of the posterior tibial tendon act as strengthening elements for the glenoid, laterally completed by the calcaneonavicular branch of the bifurcate (Chopart) ligament.34 This model is consistent according to Basmajian and Stecko's35 findings. (federicousuelli.com)

however, the original description of using tendon transfer for the treatment of progressive flatfoot deformity is attributed to Goldner in 1974. (medscape.com)
As the tendon fails over time, deformity of the foot and ankle may occur. (alpineorthopedics.com)
A rearfoot tarsal coalition can create a rigid pes planus deformity and limit the function of the posterior tibialis tendon. (msdmanuals.com)

Abnormal foot mechanics due to nerve or muscle damage, causing an imbalance of the flexor and extensor tendons of the toe. (weebly.com)
Coursing posterolaterally through the tarsal tunnel, the flexor digitorum longus- and flexor hallucis longus tendons can be found respectively. (ankleplatform.com)
Between the flexor digitorum longus- and flexor hallucis longus tendon the posterior tibial nerve, - artery and - veins are situated. (ankleplatform.com)

Results from a 1969 study by Kettelkamp and Alexander revealed that when patients demonstrated tendon rupture and surgical correction was delayed, a poor outcome with surgical exploration resulted. (medscape.com)
In cases of chronic tendinosis without rupture, the medial column (arch) height decreases gradually. (msdmanuals.com)

8] This was followed by articles by Fowler and Williams, who each presented posterior tibial tendinitis as a syndrome, with the suggestion that surgical intervention may play a role in the treatment of this condition. (medscape.com)
Surgical debridement of tenosynovitis in early stages is believed to possibly prevent progression of disease to later stages of dysfunction. (weebly.com)

18] Dorsiflexion of the toes during the gait cycle results in tightening of the plantar fascia, which ultimately elevates the arch. (medscape.com)
A review of plantar heel pain of neural origin: differential diagnosis and management. (medscape.com)
Palpation of the tendon with the foot in an inverted plantar flexed position with applied resistance is usually painful. (msdmanuals.com)

The spring-ligament complex has received much attention as an important stabilizer of the medial arch. (medscape.com)
It is unusual to find an isolated Spring Ligament (SL) tear, with an intact TP tendon. (qxmd.com)

Diagnosis is often a process of elimination as sinus tarsi syndrome is rarely a definitive disorder. (wikipedia.org)
Entrapment of the posterior tibial nerve in the tarsal canal is commonly known as a tarsal tunnel syndrome. (ankleplatform.com)

Several muscles and tendons around the ankle and foot act to counter-balance the action of the posterior tibial tendon. (alpineorthopedics.com)
Any injury to this tendon, which runs on the arch side of the ankle and foot, can affect its ability to maintain an arch in the foot and can result in a flat foot. (footankleinstitute.com)

When the posterior tibial tendon fails, the other muscles and tendons become relatively overpowering. (alpineorthopedics.com)
This condition can often be treated without surgery by strengthening the involved muscles and tendons and by bracing the ankle. (weebly.com)
Tendons are strong tissues that connect muscles to bone. (bone-joint.com)

Other imaging modalities such as multi-detector computed tomography and magnetic resonance imaging in early cases for the differential diagnosis can add additional details on the amount of cartilage affected, bone stock, fragmentation, and associated soft tissue injuries. (bvsalud.org)

The posterior tibial tendon plays a central role in maintaining the arch of the foot when you stand and walk. (alpineorthopedics.com)

Mostly a dysfunctioning posterior tibial tendon evolves in a painful tenosynovitis. (ankleplatform.com)
Tenosynovitis is also a common extra-articular manifestation of rheumatoid arthritis, where hindfoot problems are a significant cause of disability. (ankleplatform.com)
Tenosynovitis in rheumatoid patients eventually leads to a ruptured tendon. (ankleplatform.com)
MRI or ultrasonography can confirm a fluid collection around the tendon (indicating tenosynovitis) or the extent of chronic degradation or tearing to the tendon with associated tendinosis. (msdmanuals.com)

More commonly, the tendon is injured from "wear and tear" over time. (alpineorthopedics.com)
The medial arch reconstruction technique of an isolated SL tear in 5 patients is presented discussed in this paper. (qxmd.com)

In the absence of intra-articular ankle pathology, posteromedial ankle pain is most often caused by disorders of the posterior tibial tendon. (ankleplatform.com)

Dr. Reichard will look at the location of the pain, shape of your foot, flexibility of the hindfoot joints, and how you walk to make the diagnosis and assess how advanced the problem is. (alpineorthopedics.com)
In addition, advanced tendinopathy can result in a collapsed foot arch, which on radiograph shows loss of arch height and joint malalignment of the subtalar, talonavicular, naviculocuneiform, and/or the calcaneocuboid joints. (msdmanuals.com)
This can happen when two bones in the rear of the foot are fused together from birth, rendering the joints of the hindfoot and foot, in general, less mobile. (footankleinstitute.com)

A large number of tendon repair techniques have been described for acute tendon injury. (qxmd.com)

When non-operative treatment fails, surgery can improve the alignment replace the injured tendon. (weebly.com)

This change in gait can exacerbate the problem by increasing pressure on the arch and collapsing the foot alignment. (footankleinstitute.com)
The various casted, semirigid orthoses support the medial longitudinal arch of the foot and either hold the heel in a neutral alignment (stage I) or correct the outward bent heel to a neutral alignment (stage II). (weebly.com)

Clinical examination is normally sufficient to adequately differentiate these disorders from an isolated posterior tibial tendon disorder. (ankleplatform.com)
Early diagnosis and emergent operative release afforded an excellent clinical outcome. (qxmd.com)

It occurs once the heel strikes the ground and the foot disperses the impact, stretching and flattening the arch as the foot rolls inward. (weebly.com)
This flattening occurs as the posterior tibial tendon (a tendon in your lower leg) wears down. (alpineorthopedics.com)
Posterior tibial tendon dysfunction occurs more commonly in patients who are born with a flat foot or who develop the condition for other reasons. (alpineorthopedics.com)

Following trauma, surgery, and fractures, adhesions and irregularity of the posterior aspect of the tibia can be responsible for symptoms in this region. (ankleplatform.com)
In early stages, symptoms often include pain and swelling along the posterior tibial tendon behind the inside of the ankle. (alpineorthopedics.com)
Once these symptoms have resolved, patients may transition to using an arch support or orthotic that supports the inside of the hindfoot. (alpineorthopedics.com)

In the case of posterior tibial tendon dysfunction causing flatfloot, sinus tarsi can also develop due to the disruption in the entire structure of the foot. (wikipedia.org)

In general, early stage disease usually can be treated with tendon and ligament procedures with the addition of osteotomies (cutting/shortening of bone) to realign the foot. (alpineorthopedics.com)
The foot rotates inward (pronation), the heel bone is tilted to the inside, and the arch appears collapsed. (weebly.com)

Diagnosis and treatment of adult flatfoot. (qxmd.com)

With early-stage disease that involves pain along the tendon, immobilization with a boot for a period of time can relieve stress on the tendon and reduce the inflammation and pain. (alpineorthopedics.com)

The tight muscle and tendon bring the heel off the ground too early with each step. (footankleinstitute.com)
The longitudinal arches of the foot are present on heel elevation (tiptoe standing) and non-bearing but disappear with full weight bearing on the foot. (physio-pedia.com)
The longitudinal arches of the foot are absent in both heel elevation (tiptoe standing) and weight bearing. (physio-pedia.com)

This medical condition can result from continually straining the feet and wearing footwear that lacks sufficient foot arch support. (weebly.com)

An ultrasound exam performed in the office setting can evaluate the status of the posterior tibial tendon, the tendon which is primarily responsible for supporting the arch structure of the foot. (weebly.com)

When the posterior tibial tendon does not work properly, a number of changes can occur to the foot and ankle. (alpineorthopedics.com)
Examination by your foot and ankle specialist can confirm the diagnosis for most patients. (weebly.com)
American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot score at the last follow-up was obtained to assess functional result for all cases. (inion.com)

If you have flat feet, also known as pes planus, you will have a very low arch or no arch at all, meaning one or both of your feet press flat on the ground. (footankleinstitute.com)

The posterior tibial tendon creates the arch and supports the foot when you push off your toes when walking and running. (footankleinstitute.com)

However, when the foot arch remains flat and the foot rolls inward too much one may have excessive pronation or overpronation. (weebly.com)

and an older group of patients whose tendon dysfunction is mostly caused by chronic overuse. (ankleplatform.com)

Anatomy6

Diseases6

Valgus6

Insufficiency4

Ligaments9

Tibialis posterior3

Sheath4

Main tendon1

Aspect of the ankle1

Varus3

Peritalar1

Lateral4

Ruptures1

Medial malleolus7

Achilles tendon5

Navicular4

Collapse9

AAFD6

Tibia and fibula2

Deltoid ligament1

Deformity3

Flexor3

Rupture2

Surgical2

Plantar3

Spring-ligament2

Syndrome2

Ankle and foot2

Muscles3

Differential diagnosis1

Maintaining the arch of the foot1

Tenosynovitis4

Tear2

Pathology1

Joints3

Acute1

Fails1

Alignment2

Clinical2

Occurs3

Symptoms3

Sinus tarsi1

Bone2

Flatfoot1

Inflammation1

Heel3

Footwear1

Primarily1

Foot and ankle3

Planus1

Creates1

Pronation1

Chronic1