Flat Foot - Posterior Tibialis Tendon Dysfunction
Posterior tibial tendon dysfunction (flatfoot) is one of the most common causes of foot and ankle pain.
Muscles are responsible for joint mobilization, and ligaments help to limit and stabilize joint movements by preventing dislocations. The posterior tibial tendon originates in the tibia and runs along the posterior and internal aspect of the leg, passing through the ankle(internal malleolus). to insert on the first metatarsal and first toe, as well as branches that end in the plantar region of the midfoot.
The posterior tibial tendon is one of the elements that helps maintain the internal arch of the foot.
When the tendon becomes inflamed or repeatedly injured, the plantar arch may be observed to decrease until the adult acquired flatfoot is formed.
What signs do patients with acquired flatfoot present?
- Pain in the medial and posterior part of the ankle.
- Occasionally, inflammation of the area occurs.
- Discrete decrease of the internal arch of the foot with flattening.
- Pain and limitation when standing on tiptoe.
- Tenderness and pain in the central part of the foot in dorsal flexion.
- Ankle pain during impact activities (e.g., basketball).
What are the risk factors?
There is a higher prevalence of acquired flatfoot in women over 50 years of age.
The main risk factors are:
- Previous ankle surgery or trauma.
- Local corticosteroid infiltrations.
- Inflammatory and degenerative diseases such as arthritis, arthritis-psoriasis, spondyloarthropathy, etc.
- Impact sports such as basketball, tennis and soccer can injure the posterior tibial tendon.
- Others: obesity, diabetes mellitus, vasculopathies and neuropathies.
How is acquired flatfoot diagnosed?
For a correct diagnosis, the patient’s history should be assessed and a physical examination should be performed.
The medical and podiatric team should also perform a dynamic and static gait study to assess the different pressures exerted on the plantar support.
The patient may also be asked to stand on tiptoe.
Finally, X-rays of the foot, ultrasound or magnetic resonance imaging may be performed to determine if there are musculotendinous lesions.
What treatments are available?
Over time and without treatment, this dysfunction can lead to chronic stiffness of the internal plantar arch.
Hindfoot arthropathy occurs and pain increases.
In early stages, posterior tibial tendon dysfunction can be treated with rest, anti-inflammatories and custom orthotics under a plaster cast.
When conservative treatments fail, surgery may be considered.
There are several surgical procedures to treat acquired flatfoot.
These include:
- Tenosynovectomy: consists of debriding the inflamed tissue around the tendon.
- Osteotomy: allows to modify the alignment of the calcaneus.
- Tendon transfer: sometimes a tendon transfer is performed to repair the damaged tendon.
- Arthrodesis: in very advanced stages of acquired flatfoot with significant osteoarthritis, a fusion of the bones of the posterior part of the foot can be performed.
Flatfoot is a condition in which the arch of the foot is flattened, causing the entire sole of the foot to touch the ground when standing.
Although it may be asymptomatic in many people, in some cases it can cause pain and mobility problems.
This condition may be congenital or develop over time due to factors such as obesity, aging or tendon injuries.
A crucial aspect in the treatment of flatfoot is early and accurate diagnosis.
Clínica San Román performs a dynamic and static gait study to evaluate plantar pressures and posterior tibial tendon function.
This detailed approach allows us to customize treatment, which can range from the use of custom orthopedic insoles to surgical interventions.
In addition to traditional treatments, Clínica San Román is distinguished by its use of advanced technologies such as fluoroscopy and 4D ultrasound, ensuring accurate diagnoses and effective treatments.
Minimally invasive surgery is an option for severe cases, offering a faster and less painful recovery for patients.
The combination of experience and advanced technology positions Clínica San Román as a reference in the treatment of podiatric problems.
