Posterior Tibial Tendon Dysfunction

Posterior Tibial Tendon Dysfunction refers to either a sudden or progressive weakening of the posterior tibialis tendon, which is responsible for the dynamic stabilisation of the medial longitudinal arch.

In their study on the morphology and vascularisation of the tendon before and after a 12-week exercise programme, Kulig et al. state that the condition is characterised by fibroblastic hypercellularity and neovascularisation; the gradual collagen bundle degeneration and subsequent disarray impedes the optimal functioning of the posterior tibialis tendon.

A loss of strength of the posterior tibialis tendon is considered to be the most common cause of adult-acquired flatfoot, even though there are many other factors that could potentially contribute to a flatfoot deformity.

Besides acting as a key stabiliser of the medial longitudinal arch, the posterior tibialis tendon also helps in inversion and supination of the foot during gait, controlling pronation and facilitating weight distribution through the metatarsal heads.

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While the exact aetiology of posterior tibial tendon dysfunction remains unclear, Bowring and Chockalingam categorise its suggested causes as: acute traumatic injury, inflammatory synovitis secondary to mechanical overuse or systemic disease and chronic tendon degeneration.

Factors which are considered to increase the risk of developing posterior tibial tendon dysfunction include the onset of inflammatory diseases such as rheumatoid arthritis, diabetes, smoking, ageing, obesity and menopause.

Management and treatment strategies for posterior tibial dysfunction can either be surgical or nonsurgical – an early diagnosis can prevent the need for surgical treatment.

Once a passive care programme has been implemented, rehabilitation of the posterior tibialis tendon in the form of eccentric strengthening exercises can help in preventing recurrence or progression of the condition in addition to stretching of the gastrocnemius and soleus muscles to prevent restriction of ankle dorsiflexion.

This needs to be enforced in conjunction with the use of customised foot orthotics such as MASS4D® to provide structural support to the feet, which would help in controlling severe pronatory forces often associated with posterior tibial dysfunction and in strengthening the weakened musculotendinous unit.

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References:

1. Bodill, C., Concannon, M. (2012) Treatments for posterior tibial tendon dysfunction. Practice Nursing: August 2012, Vol. 23, No. 3, pp. 30-35
2. Bowring, B., Chockalingam, N. (2010) Conservative treatment of tibialis posterior tendon dysfunction—A review. The Foot: March 2010, Vol. 20, pp. 18-26
3. Kulig, K., Lederhaus, E. S., Reischl, S., Arya, S., Bashford, G. (2009) Effect of Eccentric Exercise Program for Early Tibialis Posterior Tendinopathy. Foot & Ankle International: September 2009, Vol. 30, No. 9, pp. 877-885

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