Kenneth A. Johnson, MD
Tibialis posterior tendon dysfunction is a problem which can be easily overlooked. Once aware of its presentation, stages of abnormalities of the tendon, and associated findings, physicians are more likely to recognize the dysfunction. Physicians can benefit patients with tibialis posterior tendon dysfunction through a nonoperative program. Or, if the patient has continued inflammation, a surgical treatment of the tendon.
The patient that presents with problems in their tibialis posterior tendon is more likely to be a woman, usually about 40 to 60 years of age, and without any traumatic event. Spontaneous in nature, patients will start developing pain and notice swelling on the inner side of their ankle. On examination, palpation along the course of the tibialis posterior tendon, just distal to the tip of the medial malleolus, will demonstrate a full feeling or even slight fluctuance with fluid in the tendon sheath, which will be painful to the patient at a specific point just distal or downwards from the tip of the medial malleolus.
Diagnostic testing for this malady should include: weakness testing, by having the patient perform single heel raises, and by visually examining for deformity via the "too many toes test." By completing these two simple tests, orthopaedists should be able to stage the involvement of the tendon's dysfunction according to the staging classification chart found above.
Radiographs and MRIs can also be very helpful in the diagnostic work-ups for these patients. A weight-bearing lateral view shows that the calcaneus and cuboid, as well as the other bones towards the front of the foot, will be rotated laterally from underneath the talus. This allows the head of the talus to go into a plantar flexed position, and therefore the angle between the calcaneus and the talus has been increased. If there is any question as to the diagnosis of the involvement of the tibialis posterior tendon, even after physical examination and X-ray, MRI scans will show changes in the size of the tibialis posterior tendon.
Of the three stages of tibialis posterior tendon dysfunction, Stage I is best treated nonoperatively while stages II and III require surgical management. Stage II tibialis posterior tendon dysfunction can be best managed by flexor digitorum longus transfer. However, Stage III tibialis posterior tendon dysfunction is contraindicated for the flexor digitorum longus transfer and requires arthrodesis.
- Johnson KA Tibialis Posterior Tendon Rupture Clin Orthop 1983;177:140-147
- Total Run Time: 29:45 minutes
- Catalog Number: 1015
- VJO Publication Date: April, 1994