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grotesquesuburb53

What Can Cause Posterior Tibial Tendon Dysfunction ?

Overview
The posterior tibialis muscle originates on the bones of the leg (tibia and fibula). This muscle then passes behind the medial (inside) aspect of the ankle and attaches to the medial midfoot as the posterior tibial tendon. The posterior tibial tendon serves to invert (roll inward) the foot and maintain the arch of the foot. This tendon plays a central role in maintaining the normal alignment of the foot and also in enabling normal gait (walking). In addition to tendons running across the ankle and foot joints, a number of ligaments span and stabilize these joints. The ligaments at the medial ankle can become stretched and contribute to the progressive flattening of the arch. Several muscles and tendons around the ankle and foot act to counter-balance the action of the posterior tibial tendon. Under normal circumstances, the result is a balanced ankle and foot with normal motion. When the posterior tibial tendon fails, the other muscles and tendons become relatively over-powering. These muscles then contribute to the progressive deformity seen with this disorder. Adult acquired flat feet

Causes
Rheumatoid arthritis This type of arthritis attacks the cartilage in the foot, leading to pain and flat feet. It is caused by auto-immune disease, where the body?s immune system attacks its own tissues. Diabetes. Having diabetes can cause nerve damage and affect the feeling in your feet and cause arch collapse. Bones can also fracture but some patients may not feel any pain due to the nerve damage. Obesity and/or hypertension (high blood pressure) This increases your risk of tendon damage and resulting flat foot.

Symptoms
Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area. Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time. Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot. Asymmetrical collapsing of the medial arch on the affected side.

Diagnosis
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
Conservative treatment is indicated for nearly all patients initially before surgical management is considered. The key factors in determining appropriate treatment are whether acute inflammation and whether the foot deformity is flexible or fixed. However, the ultimate treatment is often determined by the patients, most of whom are women aged 40 or older. Compliance can be a problem, especially in stages I and II. It helps to emphasise to the patients that tibialis posterior dysfunction is a progressive and chronic condition and that several fittings and a trial of several different orthoses or treatments are often needed before a tolerable treatment is found. Acquired flat foot

Surgical Treatment
If initial conservative therapy of posterior tibial tendon insufficiency fails, surgical treatment is considered. Operative treatment of stage 1 disease involves release of the tendon sheath, tenosynovectomy, debridement of the tendon with excision of flap tears, and repair of longitudinal tears. A short-leg walking cast is worn for 3 weeks postoperatively. Teasdall and Johnson reported complete relief of pain in 74% of 14 patients undergoing this treatment regimen for stage 1 disease. Surgical debridement of tenosynovitis in early stages is believed to possibly prevent progression of disease to later stages of dysfunction.

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