Posterior Tibialis Tendon Dysfunction

• Causes:

  • Intrinsic:
  • Avascular zone as it passes behind the medial malleoli
  • more common in females
  • Inflammatory:
  • Sero-negative arthropathy
  • Mechanical/Extrinsic (most common)
  • Excessive valgus at subtalar joint - leads to increased demand on tendon

  
• Signs and symptoms:

  • +/- medial ankle swelling
  • +/- decreased medial longitudinal arch
  • increased amount of valgus in subtalar joint
  • "too many toes sign" - shown by subtalar joint valgus and forefoot abduction - can see 4/5 toes pointing outwards from behind patient
  • double heel raise - cant correct subtalar joint from valgus position
  • tenderness on palpation under tip of medial malleolus, navicular insertion
• PTTD classification:

  • physiotherapy can benefit patients with PTTD in stage 1 and 2A
  • from stage 2B onwards it requires further assistance

  
• Management:

  • Manage symptoms
  • Graduated Loading of tibialis posterior tendon - Varus, adduction, inversion, plantarflexion and muscles around the calf, knee and hip
  • Progress to functional and specific