Ankle
Posterior Tibial Tendinopathy
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Posterior Tibial Tendinopathy
, Posterior Tibial Tendonitis, Posterior Tibial Tendinitis
Physiology
Posterior Tibial Tendon function
Foot
inversion and plantar flexion
Medial longitudinal arch stabilization
Epidemiology
Gender predominance in women
Typically over age 40 years
Causes
Typically, no recollection of acute injury
Twisting foot
Stepping in hole
Slipping from curb
Symptoms
Years of pregressive pain along the lateral tarsal region
Signs
Pain and swelling posterior to medial malleolus
Flat foot deformity
Medial ankle instability (severe cases where the deltoid ligament stretched)
Provocative factors
Weight bearing
Foot
inversion against resistance
Plantar flexion against resistance
Specific testing
Heel varus is absent when standing on tiptoe
Pain with single-leg toe raise and unable to complete 10
Plantar flexion ability lost (peroneal tendon rupture)
Evaluation
Stages of Posterior Tibial Tendinopathy
Stage 1
Pain and swelling of posterior tibial tendon
No foot deformity
Patient can perform single-leg heel raise
Stage 2
Pain and swelling of posterior tibial tendon
Patient cannot perform single-leg heel raise
Flexible subtalar joint
Pes Planus
Midfoot adduction
Stage 3
Stage 2 and
Subtalar joint is fixed
Ankle
Arthritis
Differential Diagnosis
Medial Ankle Sprain
(most common misdiagnosis)
Flexor digitorum longus
Tendinopathy
Flexor Hallucis Longus Tendinopathy
Tarsal Navicular Stress Fracture
Tarsal Tunnel Syndrome
Management
RICE-M
Immobilization (e.g. CAM Walker boot) for 2-3 weeks
Shoe
Orthotic
(decrease foot pronation)
Posterior tibial tendon strengthening
Avoid
Corticosteroid Injection
(risk of posterior tibial tendon rupture)
Orthopedic referral indications
Failed conservative therapy above
Stage 3 foot deformity (consider for stage 2)
Complications
Occur more often in the absence of treatment
Foot
deformity
Posterior tibial tendon rupture
References
Simpson (2009) Am Fam Physician 80(10): 1107-13 [PubMed]
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