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Posterior Tibial Tendon Dysfunction

Posterior Tibial Tendon Dysfunction is a common problem amongst hard working people. This is a classic over use injury and affects a particular tendon in the foot, the posterior tibial tendon. This tendon helps to hold the arch of the foot and prevents your feet from rolling in too much. The patients in step of the foot may appear inflamed and may have a pronounced flat foot deformity.

Symptoms include pain at the in step of the foot, especially along the course of the tendon. There may be burning, tingling, shooting or stabbing pain present in the foot. This is due to the inflammation of the nerve that surrounds the tendon. If a patient is asked to stand on their toes, intense pain will be present in the arch of the foot.

What causes Posterior Tibial Tendon Dysfunction

  • Posterior Tibial Tendon Dysfunctionof the posterior tibial tendon can be caused due to initial strain, minor degeneration and a rupture of the tendon. The inflammation of the tendon is a secondary reaction.
  • Initially, there is irritation of the outer covering of the tendon. This is called paratendonitis. This leads to degeneration of the tendon, which causes the tendon to become thicker. The tendon then becomes weaker and loses its strength; this can lead to a complete rupture of the tendon.
  • Flat foot types are at risk
  • Tight heel cords (Achilles Tendon) can lead to tendonitis of the foot.
  • Walking or running up hill, i.e. golf courses or marathon running can be the catalyst for tendonitis in the foot.

Diagnosis of Posterior Tibial Tendon Dysfunction

The diagnosis is based on both a history and a physical examination. Your physician may ask you to stand on your bare feet facing away from him/her to view how your foot functions. As the condition progresses, the front of the affected foot will start to slide to the outside. From behind, it will look as though you have "too many toes" showing. You may also be asked to stand on your toes or to do a single heel rise: stand with your hands on the wall, lift the unaffected foot off the ground, and raise up on the toes of the other foot. Normally, the heel will rotate inward; the absence of this sign indicates posterior tibial tendon dysfunction. Your doctor may request X-rays, an ultrasound or a magnetic resonance image (MRI) of the foot.

Treatment of Posterior Tibial Tendon Dysfunction

  • Rest
  • Ice
  • Compression
  • Anti-inflammatory medication
  • Cease all sporting activities and try and stay off your feet as much as possible.
  • Orthosis (insoles) may be necessary. This will help to support the arch region of the foot. In our experience, this is the most effective form of treatment.
  • In severe cases surgery may be necessary to repair the tendon.

Without treatment, the flatfoot that develops from posterior tibial tendon dysfunction eventually becomes rigid. Arthritis develops in the hindfoot. Pain increases and spreads to the outer side of the ankle. The way you walk may be affected and wearing shoes may be difficult.

The treatment your doctor recommends will depend on how far the condition has progressed. In the early stages, posterior tibial tendon dysfunction can be treated with rest, nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen, and immobilization of the foot for 6 to 8 weeks with a rigid below-knee cast or boot to prevent overuse. After the cast is removed, shoe inserts such as a heel wedge or arch support may be helpful. If the condition is advanced, your doctor may recommend that you use a custom-made ankle-foot orthosis or support.

If conservative treatments don’t work, your doctor may recommend surgery. Several procedures can be used to treat posterior tibial tendon dysfunction; often more than one procedure is performed at the same time. Your doctor will recommend a specific course of treatment based on your individual case. Surgical options include:

  • Tenosynovectomy. In this procedure, the surgeon will clean away (debride) and remove (excise) any inflamed tissue surrounding the tendon.
  • Osteotomy: This procedure changes the alignment of the heel bone (calcaneus). The surgeon may sometimes have to remove a portion of the bone.
  • Tendon transfer: This procedure uses some fibers from another tendon (the flexor digitorum longus, which helps bend the toes) to repair the damaged posterior tibial tendon.
  • Lateral column lengthening: In this procedure, the surgeon removes a small wedge-shaped piece of bone from the hip and places it into the outside of the calcaneus. This helps realign the bones and recreates the arch.
  • Arthrodesis: This procedure welds (fuses) one or more bones together, eliminating movement in the joint. This stabilizes the hindfoot and prevents the condition from progressing further.
 
 
 
 
 
 
   

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08/05/2010

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