The posterior tendon is one of the primary supporting structures of the foot as it helps in the functioning of the foot. Posterior tibial tendon dysfunction is a condition that is caused by changes in the tendon which leads to its failure to support the arch. This results in adult acquired flatfoot.

Posterior tibial tendon dysfunction is the most common type of adult acquired flatfoot. It is a condition which occurs on one foot but in some rare cases, it can develop in both feet. This is a progressive condition, meaning it can get worse if not treated in its early stages.

Causes of Tibial Posterior Dysfunction

Overusing the posterior tibial tendon is the most common cause of Tibial’s posterior dysfunction. The symptoms usually show up after activities which involve the tendon such as walking, running, hiking or climbing.

Symptoms of Tibial Posterior Dysfunction

Symptoms of Tibial’s posterior dysfunction occur in stages as the condition progresses.

Stage I: In this stage, the posterior tibial tendon tends to be painful but there is no sign of deformity or collapse of the arch. The patient’s foot usually appears normal at this stage, but the area may be warm and red.

Stage II: The deformity starts to occur at this stage resulting in the collapse of the arch which may or may not be visible yet. It can although be experienced as a feeling of weakness in the arch. Most patients notice that they have a foot condition at this stage. This is due to the fact that the tendon failure and ligament function can occur at the same time thus beginning the deformity. In addition to the pain, the toes and foot begin to turn outward while the ankle rolls inward.

Stage III: In this stage, the deformity has progressed, and the foot tends to become rigid in the deformed position.

Stage IV: This is the most severe stage. The ligament inside the ankle (the deltoid ligament) fails and this results in an ankle as well as a foot deformity. With time, this can progress to arthritis of the ankle.

Treatment of Tibial Posterior Dysfunction

Because Tibial’s posterior dysfunction is a progressive condition, it is advisable to seek treatment as early as possible. If treated at an early stage, the symptoms will likely resolve without the need for surgery and the progression for the condition halted.

However, if not treated, Tibial’s posterior dysfunction can result in you having an extremely flatfoot, limitations on activities such as walking and running, and painful arthritis in the ankle and foot.

Treatment approaches include:

• Medication: Anti-inflammatory drugs can help in reducing the pain and inflammation.
• Immobilization: The foot is sometimes immobilized by a boot or a short-leg cast so as to allow the tendon to heal while avoiding weight bearing on it.
• Bracing or orthotic devices: You may be provided with a custom orthotic device which fits in your shoe or an ankle brace which will act as support for your arch.
• Shoe modifications: You may be asked to make changes in the kind of shoes you wear and provided with special shoe inserts which are particularly designed to improve arch support.
• Physical therapy: Exercises and ultrasound therapy can help in rehabilitating the muscle and tendon after the immobilization of the foot.
• Surgery: This is the last resort when the Tibial’s posterior dysfunction has progressed substantially or the other treatments have failed to improve the condition. There are cases whereby surgery is the only option.

Next Step

At King’s College Hospital Dubai, we focus on offering an exemplary service, from initial consultation through to final diagnosis and treatment and beyond. Our multidisciplinary team of expert doctors, nurses, physio therapists are here to offer tailored management and treatment of your condition, and to answer any questions that you might have throughout your time with us. Whatever you need us for, we’re only a phone-call away.