Tendon Disorders
TIBIALIS POSTERIOR INSUFFICIENCY
(Adapted from the Foot & Ankle Hyperbook )
Commonest cause of
adult acquired flat foot
Tears occur in the hypovascular zone 3-5 cm proximal to insertion
Causes
-
trauma
-
chronic flat foot
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inflammatory arthropathy
-
degenerative tendonopathy
Myerson described two groups:
-
younger patients aged 30-40 with inflammatory arthropathy
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older, typically female patients 50-60 years old with degenerative tears
Complaints
-
post-malleolar pain
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arch pain + aching
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progressive flat foot
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forefoot problems: progressive hallux valgus, metatarsalgia, lesser toe deformities
-
rarely,
tarsal tunnel syndrome
tarsal tunnel syndrome
tarsal tunnel syndrome
Examination
-
gait
-
planovalgus foot
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heel remains in valgus on double foot tiptoe standing
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post-malleolar tenderness/swelling with no palpable tendon on resisted plantar flexion/inversion
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single foot tiptoe test: cannot stand on tiptoe on single foot if tibialis posterior not functioning
-
tight TA
in hindfoot neutral
-
hindfoot/forefoot malalignment and its degree of correctability
Differential diagnosis
-
longstanding flat foot made symptomatic, usually by minor trauma
-
sequelae of other injuries
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joint instability or destruction due to inflammatory arthritis
-
neuropathic foot collapse
Imaging
-
Standing hindfoot alignment view: shows where the valgus is
-
Standing lateral footü both show talonavicular
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Standing AP forefootþ and talometatarsal alignment
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MR: best technique for assessing tendons
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