Dysfunction of the tibialis posterior tendon is a common condition and a common cause of acquired flatfoot deformity in adults. Women older than 40 are most at risk. Patients present with pain and
swelling of the medial hindfoot
. Patients may also report a change in the shape
of the foot or flattening of the foot. The foot develops a valgus heel (the heel rotates laterally when observed from behind), a flattened longitudinal arch, and an abducted forefoot. Conservative
treatment includes non-steroidal anti-inflammatory drugs, rest, and immobilisation for acute inflammation; and orthoses to control the more chronic symptoms. Surgical treatment in the early stages is
hindfoot osteotomy combined with tendon transfer. Arthrodesis of the hindfoot, and occasionally the ankle, is required in the surgical treatment of the later stages of tibialis posterior
The posterior tibial tendon, which connects the bones inside the foot to the calf, is responsible for supporting the foot during movement and holding up the arch. Gradual stretching and tearing of
the posterior tibial tendon can cause failure of the ligaments in the arch. Without support, the bones in the feet fall out of normal position, rolling the foot inward. The foot's arch will collapse
completely over time, resulting in adult acquired flatfoot. The ligaments and tendons holding up the arch can lose elasticity and strength as a result of aging. Obesity, diabetes, and hypertension
can increase the risk of developing this condition. Adult acquired flatfoot is seen more often in women than in men and in those 40 or older.
Most people will notice mild to extreme pain in their feet. Below outlines some signs and symptoms of AAFD. Trouble walking or standing for any duration. Pain and swelling on the inside of the ankle.
Bump on the bottom of the foot. Ulcer or wound developing on the outer aspects of foot.
In the early stages of dysfunction of the posterior tibial tendon, most of the discomfort is located medially along the course of the tendon and the patient reports fatigue and aching on the
plantar-medial aspect of the foot and ankle. Swelling is common if the dysfunction is associated with tenosynovitis. As dysfunction of the tendon progresses, maximum pain occurs laterally in the
sinus tarsi because of impingement of the fibula against the calcaneus. With increasing deformity, patients report that the shape of the foot changes and that it becomes increasingly difficult to
wear shoes. Many patients no longer report pain in the medial part of the foot and ankle after a complete rupture of the posterior tibial tendon has occurred; instead, the pain is located laterally.
If a fixed deformity has not occurred, the patient may report that standing or walking with the hindfoot slightly inverted alleviates the lateral impingement and relieves the pain in the lateral part
of the foot.
Non surgical Treatment
There are many non-surgical options for the flatfoot. Orthotics, non-custom braces, shoe gear changes and custom braces are all options for treatment. A course of physical therapy may be prescribed
if tendon inflammation is part of the problem. Many people are successfully treated with non-surgical alternatives.
A new type of surgery has been developed in which surgeons can re-construct the flat foot deformity and also the deltoid ligament using a tendon called the peroneus longus. A person is able to
function fully without use of the peroneus longus but they can also be taken from deceased donors if needed. The new surgery was performed on four men and one woman. An improved alignment of the
ankle was still evident nine years later, and all had good mobility 8 to 10 years after the surgery. None had developed arthritis.