Tibialis Posterior Tendon Dysfunction

Information

Tibialis Posterior Tendon Dysfunction is a progressive and potentially debilitating disorder, which can be detrimental to patients due to limitations in mobility, significant pain, and weakness and deformity if not managed.

This problem typically presents as pain and mild swelling of the tendon posterior to the medial malleolus, potentially spreading distally into the medial plantar mid foot. Symptoms are usually experienced on activity and after rest periods.

Tibialis Posterior Tendon Dysfunction occurs when the tendon becomes inflamed, torn or degenerative, resulting in poor muscle function and lack of foot inversion power and medial foot strength. Tendon degeneration commonly begins far before clinical disease is apparent therefore early detection of this condition is essential in minimising dysfunction and long term foot and ankle structural changes.

Left unmanaged, Tibialis Posterior Tendon Dysfunction can lead to development of a fixed adult acquired flatfoot deformity. Risk factors for the condition include hypertension, obesity, diabetes, rheumatoid arthritis and previous tibialis posterior tendon trauma.

Tibialis Posterior Tendon Dysfunction can be categorised into four stages: 

• Stage 1
  • Posterior tibial tendon intact and inflamed, no deformity, mild swelling.
  • Localised tendinopathy.
  • Minimal/ no other structural changes.
• Stage 2
  • Posterior tibial tendon dysfunctional. Swelling inferior to medial malleolus.
  • Acquired pes planus but passively correctable. Hindfoot generally normal.
  • Commonly unable to perform a heel raise.
• Stage 3
  • Degenerative changes in the subtalar joint and the deformity is fixed.
  • Midfoot and subtalar joint degeneration evident on assessment and imaging.
  • Tendon elongated and fully dysfunctional with little to no power.
• Stage 4
  • Stiff flatfoot deformity.
  • Fixed everted hindfoot deformity.
  • Valgus tilt of talus leading to lateral tibiotalar degeneration.