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What is posterior tibial tendon dysfunction?

Flat foot is quite a common disorder of the foot, but most of the time simply having a lower mid-foot (arch) or flatter foot is not necessarily a problem. What is a concern is if it is progressive and becomes painful, then it is known as posterior tibial tendon dysfunction or adult acquired flatfoot. In these cases the arch of the foot becomes steadily flatter and the rearfoot rolls inwards. This is usually followed by pain in the arch of the foot and in the ankle region. Those with this also find walking is a lot is a lot and walking uses a lot of effort resulting in a lot of tiredness.The explanation for posterior tibial tendon dysfunction is not fully understood, but it is a problem where the posterior tibial tendon and muscle can't just do the job that it is designed for. The main role of the posterior tibial tendon is to support the arch of the foot and stop the heel rolling inwards. For some reason the muscle and tendon unit can't just do that task any more, resulting in the progressive nature of this problem.

The management of posterior tibial tendon dysfunction is somewhat urgent and needs to be dealt with as soon as it possibly can. The reason being the disorder is progressive and it will reach a point where conservative measures do not work and surgery is the only choice. As the surgical outcomes are in general acceptable, they do consist of the fusion of some joints to stop the disorder getting worse, that comes with some long term limitations on gait and function, so is best avoided. In order to avoid the surgical intervention, treatment options needs to be started early. This will likely consist of foot supports that are really supportive and position the foot back in the correct direction. Exercises are also encouraged, but should never be used instead of foot orthotics, as they are important to stop the flat foot from progressing.