Posterior Tibialis Tendon Dysfunction: Overview of Evaluation and Management

Abstract

EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Recognize posterior tibialis tendon dysfunction and begin to include it in differential diagnoses. 2. Recall the basic anatomy and pathology of the posterior tibialis tendon. 3. Assess a patient for posterior tibialis tendon dysfunction with the appropriate investigations and stratify the severity of the condition. 4. Develop and formulate a treatment plan for a patient with posterior tibialis tendon dysfunction. The posterior tibialis is a muscle in the deep posterior compartment of the calf that plays several key roles in the ankle and foot. Posterior tibialis tendon dysfunction is a complex but common and debilitating condition. Degenerative, inflammatory, functional, and traumatic etiologies have all been proposed. Despite being the leading cause of acquired flatfoot, it is often not recognized early enough. Knowledge of the anatomical considerations and etiology of posterior tibialis tendon dysfunction, as well as key concepts in its evaluation and management, will allow health care professionals to develop appropriate intervention strategies to prevent further development of flatfoot deformities.

Ultrasound evaluation of adult‐acquired flatfoot deformity: Emphasis on the involvement of spring ligament

“…The larger and superomedial is a hammock-shaped ligament, it courses along the medial margin of the talonavicular articular surface, it arises from the under surface of the sustentaculum tali and has a fanlike insertion on the inferior and medial Correspondence to email q.sirlyn@capitalradiology.com.au doi: 10.1002/ajum.12050 surfaces of the navicular bone. 2,13,18 The histopathological characteristic of TPT obtained from the specimens of AAFD further shows the concept of degenerative tendinosis without inflammation as believed to be the underlying pathological mechanism in chronic TPT dysfunction. It is a striplike bundle of short and thick fibres and originates in the notch between the middle and anterior calcaneal facets, spreading out and terminating on the inferior beak of the navicular bone.…”

“…34 Clinical staging of the condition has been well accepted. 2,13,38 The normal TPT will exhibit hyperechoic texture with an AP diameter between 4 and 6 mm 2 . 30 For instance, antero-posterior and lateral X-ray of the foot with weight bearing will demonstrate an increased talometatarsal angle and decreased calcaneoplantar angle, indicating the extent of the planovalgus deformity.…”

“…2,10 The distal tendon is enclosed within a synovial sheath, formed in the distal third of the leg, where it courses immediately posterior to the medial malleolus (MM) and is firmly held down by the flexor retinaculum. 2,10 The distal tendon is enclosed within a synovial sheath, formed in the distal third of the leg, where it courses immediately posterior to the medial malleolus (MM) and is firmly held down by the flexor retinaculum.…”

“…2,11,12 Distal to this region the tendon exhibits a more flattened orientation and divides into multiple fibrous slips, the biggest component inserts into the navicular tuberosity with branches inserting into the cuneiform bones and the bases of the first to fourth metatarsals. 2,13 The calcaneo-navicular (spring) ligament complex fills the bony gap between the anterior part of the calcaneus and the navicular bone. 2,13 The calcaneo-navicular (spring) ligament complex fills the bony gap between the anterior part of the calcaneus and the navicular bone.…”

“…2 It is characterised by a flattened longitudinal arch, the development of a valgus heel with a gradually abducting and supinating forefoot. 2,4 Tibialis posterior tendon (TPT) dysfunction is the commonest cause of AAFD, but is not a sole pathological entity. 2,4 Tibialis posterior tendon (TPT) dysfunction is the commonest cause of AAFD, but is not a sole pathological entity.…”