Posterior tibial tendon dysfunction is the most common cause of adult acquired flatfoot. Degenerative changes in this tendon, lead to pain and weakness and if not identified and treated will progress to deformity of the foot and degenerative changes in the surrounding joints. Patients will complain of medial foot pain, weakness, and a slowly progressive foot deformity. A “too many toes” sign may be present and patients will be unable to perform a single heal raise test. Investigations such X-ray, ultrasound and magnetic resonance imaging will help stage the disease and decide on management. The optimal manage may change based on the progression of deformity and stage of disease. Early identification and prompt initiation of treatment can halt progression of the disease. The purpose of this article is to examine the causes, signs, symptoms, examinations, investigations and treatment options for posterior tibial tendon dysfunction.

TASH compares favorably with surgical myectomy with regard to symptom resolution, rate of complications and mortality in a tertiary referral centre and should be seen as an attractive alternative to surgical myectomy in the appropriate patient population.

Extracorporeal life support has evolved to become a viable support option in patients with acute cardiac failure. Tailored mechanical circulatory support (MCS) can now be provided to patients using existing extracorporeal life support devices. 1 We report the successful use of peripheral venoarterial extracorporeal membrane oxygenation (ECMO) to provide MCS to a patient with acute 5-flurouracil (5-FU)-induced cardiomyopathy. 5-FU is a key component of adjuvant chemotherapy for colorectal cancer. It is also frequently used in the treatment of gastric, esophageal, pancreatic, breast, bladder, and prostate cancer. There is a wide range of cardiotoxicity with this 5-FU, including ischemia, vasospasm, arrhythmia, hypertension, Q-T interval prolongation, and acute cardiomyopathy and 5-FU-induced cardiac complications are not rare.2 This case illustrates the crucial place of ECMO as a bridge to recovery in chemotherapy, cardiomyopathy, or decision making. Case ReportA 32-year-old man began adjuvant treatment for colorectal adenocarcinoma with 5-FU continuous infusion after presumed curative bowel resection. He experienced stuttering chest pain from day 1 of therapy with progressive shortness of breath. His risk factors for cardiovascular disease included a positive family history of ischemic heart disease and previous methamphetamine use. He presented to the emergency department in a peripheral hospital on completion of his first cycle, where he was noted to be in paroxysmal atrial fibrillation with rapid ventricular response alternating with sinus tachycardia with inferolateral ST elevation. Cardiac troponin was mildly elevated and a presumptive diagnosis of 5-FU-induced cardiotoxicity was made. Sublingual glyceryl trinitrate, oral atenolol, and amlodipine were administered. After this, the patient became hypotensive, with cool and clammy peripheries. He was commenced on dobutamine and noradrenaline infusions and transferred to our center.Urgent cardiac catheterization confirmed angiographically normal coronary arteries (Figure 1). His left ventricular enddiastolic pressure was elevated at 30 mm Hg. An intra-aortic balloon pump was inserted through the left femoral artery. Transthoracic echocardiogram revealed severe global dysfunction with an ejection fraction of 10% to 15% with normal valves and no pericardial effusion. There was no evidence of significant dilation or thinning of ventricular chambers, thus inferring an acute and potentially reversible process (Figure 2).The patient was transferred to the intensive care unit with severe cardiogenic shock despite intra-aortic balloon counterpulsation and high doses of dobutamine (10 μg/kg per minute), noradrenaline (0.25 μg/kg per minute), and adrenaline (0.25 μg/kg per minute). There was evidence of end-organ malperfusion with increasing lactate, altered mentation, and early hepatic and renal dysfunction. In the face of impending circulatory collapse, peripheral venoarterial ECMO was instituted as a bridge to recovery. He was deemed unsuitable for cardiac transplanta...