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One of the most common problems of the foot and ankle.
Occurs when the posterior tibial tendon becomes inflamed or torn.
With inflammation the tendon may not be able to provide stability and support for the arch of the foot.
May result in flatfoot.
Most patients can be treated without surgery with the use of orthotics and braces.
If orthotics and braces do not provide relief,
Surgery can be an effective way to help with the pain in patients not benefiting from braces an orthotics.
Surgery might limited to removing inflamed tissue or repairing a simple tear.
Surgery may limit activity after surgery.
The posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot, to hold up the arch and support the foot when walking.
The posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot.
An acute injury, can tear the posterior tibial tendon or cause it to become inflamed.
Overuse can tear the tendon.
When the tendon becomes inflamed or torn, the arch will collapse over time.
More common in women and in people older than 40 years of age.
Additional risk factors include obesity, diabetes, and hypertension.
Symptoms are pain along the inside of the foot and ankle, where the tendon lies, which may or may not be associated with swelling.
Pain increases with activity.
High-impact activities are difficult.
Some patients can have trouble walking or standing for a long time.
Pain may occur on the outside of the ankle when the foot collapses as the heel bone may shift to a new position.
Results in a flatfoot deformity, the foot points outward, and the big toe can be seen from the back of the foot.
The single limb heel rise test reflects the ability to stand on one leg and come up on tiptoes.
The single limb heel rise test requires a healthy posterior tibial tendon.
When a patient cannot stand on one leg and raise the heel, it suggests a problem with the posterior tibial tendon.
The treatment plan for posterior tibial tendon tears varies depending on the flexibility of the foot.
Symptoms will be relieved in most patients with appropriate nonsurgical treatment, although pain may last longer than 3 months.
It is not uncommon for the pain to last another 6 months after treatment starts.
The first step in management is decreasing or even stopping activities that worsen the pain.
Switching to low-impact exercise that does not put a large impact load on the foot are generally tolerated.
Applying cold packs helps to decrease the inflammation around the tendon.
Nonsteroidal anti-inflammatory medication can reduce pain and inflammation.
A short leg cast or walking boot for 6 to 8 weeks allows the tendon to rest and the swelling to go down, and is used if no other conservative treatment works.
Most patients can be helped with orthotics and braces.
A lace-up ankle brace may help mild to moderate flatfoot. supports the joints of the back of the foot and takes tension off of the tendon.
A brace can help some patients avoid surgery.
Physical therapy can strengthen the tendon and can help patients with mild to moderate disease.
Cortisone injections into the posterior tibial tendon is not normally done as it carries a risk of tendon rupture.
Surgery is considered if the pain does not get better after 6 months of appropriate treatment.
The type of surgery depends on where tendonitis is located and how much the tendon is damaged.
Surgical lengthening of the calf muscles is useful in patients who have limited ability to move the ankle up.
Surgical lengthening of the calf muscles can help prevent flatfoot from returning, but causes weakness with pushing off and climbing stairs.
Tenosynovectomy is used when there is very mild disease, the shape of the foot has not changed, and there is pain and swelling over the tendon.
Tendon transfer can be performed in flexible flatfoot to recreate the function of the damaged posterior tibial tendon.
Patients who need tendon transfer surgery are typically not able to participate in many sports activities before surgery because of pain and tendon disease.
Osteotomy can change the shape of a flexible flatfoot to recreate a more normal arch shape.
If flatfoot is severe, a bone graft may be needed to lengthen the outside of the foot.
Other bones in the middle of the foot may be cut or fused to help support the arch and prevent the flatfoot from returning.
If the flatfoot is stiff or there is also arthritis in the back of the foot, arthrodesis of a joint or joints in the back of the foot is used to realign the foot and normalize its shape and remove any arthritis.
Nonunion can be a complication with both osteotomies and fusions, and wound infection is a possible complication, as well.
Surgical outcome is determined by the amount of motion possible before surgery and the severity of the flatfoot.