Painful Progressive Flatfoot (tibialis posterior tendinitis)
Painful progressive flatfoot, otherwise
known as tibialis posterior tendinitis
occurs when the tendon of the tibialis
posterior becomes inflamed, stretched
or suffers a partial or total tear.
If left untreated, this condition may lead to severe disability
and chronic pain. Some people are predisposed to this condition
if they have flatfeet or an abnormal attachment of the tendon
to the bones in the midfoot.
Anatomy
The tibialis posterior muscle begins just below the back of the
knee and runs along the back of the leg and the tendon then
passes under the inner aspect of the ankle and attaches at the
inside of the mid-foot or arch area. The tendon is responsible
for helping to maintain the arch in the foot while the muscle
aids in lifting the heel off the ground when one walks.
Symptoms
When the tibialis posterior tendon is inflamed or partially torn,
pain is felt from the inside of the ankle to the arch area. With
a more severe injury, a swollen, or bulbous area along the inside
of the ankle may also be felt. If a sudden fall in the arch occurs,
this may indicate a complete rupture of the tendon which will
produce severe pain and requires immediate attention. The pain
is usually worse while walking and especially while rising up on
the toes. Walking up and down stairs may also be very painful.
Diagnosis
The podiatric foot and ankle surgeon will first take a complete
history and physical. Examination of the involved foot includes
palpating the area for pain and swelling while looking for
“too many toes” sign when the foot is viewed from the back.
The podiatric foot and ankle surgeon will compare the arch of
the uninvolved foot to the involved foot looking for discrepancies.
Muscle and tendon strength will be evaluated by having the
patient move the foot against resistance. A radiograph, or X-ray,
will also be taken to evaluate any bony problems along the course
of the tendon. An MRI may also be indicated to identify the
extent and specific location of the damage to the tendon.
Treatment
Conservative treatment for this condition includes use of
nonsteroidal anti-inflammatory medications, ice, physical therapy,
supportive taping and bracing, or orthotic devices. Leg and foot
casting may also be utilized in severe cases. In some instances,
conservative treatment will not relieve the pain and surgery may
be an option. Surgery for this condition involves repairing the
torn or damaged tendon to restore normal function. To prevent
reinjury, orthotic devices may be recommended. In severe cases,
surgery on the mid-foot bones may be necessary to treat the
associated flatfoot condition.
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