Tibialis Posterior Dysfunction

Dysfunction of the tibialis posterior tendon is unfortunately quite common but a problem which is frequently underestimated. The condition affects middle aged to elderly people and more commonly females. There are 3 main phases of the problem which are progressive if treatment is not started:

  • pain and swelling usually behind the inner side of the ankle
  • stretching of the tendon with pain and progressive loss of the foot arch
  • complete failure of the tendon with foot deformity and pain in the mid and hind foot

In the early stages treatment consists of anti-inflamatory medication, insoles (orthotics) and physiotherapy. If the condition is suspected then an ultrasound or MRI scan may be required to aid the diagnosis. Surgery can be very helpful and generally the earlier the better once the initial non operative treatment has been tried. Simple tendon release may be sufficient but later on if the tendon has stretched a tendon transfer may be needed along with an operation to move the heel bone which will help the stability of the foot. In the worst cases when degeneration has occurred in the hindfoot a joint fusion may be needed. A recent study confirms that the results of surgery can be expected to be positive in reducing pain, improving function and quality of living (Coster M et al Foot & Ankle surgery 2015;21:286-9)

OLYMPUS DIGITAL CAMERAPain is felt over the inner side of the foot & ankle and often swells here too.

As the tendon stretches the foot changes shape and drifts out to the side, gradually getting worse with time.

Sev type 4 degen HF In the worst cases that remain untreated the feet deform very badly and joints can become degenerate and painful