Posterior Tibialis Dysfunction

Question 1

Is this condition prevalent?

Answer 1

• Often misdiagnosed as medial ankle sprain
• Tibialis posterior is the primary stabilizer of the medial longitudinal arch
• Can reach a prevalence of 10% in elderly women
• Estimated to affect nearly 5 million people in the US.

Question 2

What pathogenic processes can be related with tibialis posterior dysfunction?

Answer 2

• Age related tendon degeneration
• Fibrotic changes as a result of repeated microtrauma
• Abnormal forces arise from even mild flatfootedness (tendencia para pronação estira o tendão), resulting in lifelong greater demands on the tibialis posterior than in a normal foot.

Question 3

List some risk factors to this condition.

Answer 3

• Female
• Sup 40 years of age
• Flatfoot (tendence to midfoot pronation with forefoot eversion - “too many toes sign”)
• Hypertension
• Diabetes
• Steroid injection
• Obesity.

Question 4

The posterior tibialis tendinopathy can be devised in four stages. What caracteristics are present in stage 1?

Answer 4

• Tenosynovitis +/- degeneration
• Deformity absent
• Medial pain
• Mild pain with heel raise
• Mild weakness with hindfoot inversion

Question 5

What we can find in stage 2 of posterior tibialis tendinopathy?

Answer 5

• Degeneration + elongation
• Flexible pes planovalgus
• Medial +/- lateral pain
• Too-many-toes sign
• Marked pain with heel raise +/- unable to perform
• Marked weakness with hindfoot inversion.

Question 6

Refer some characteristics of stage 3 of posterior tibialis tendinopathy.

Answer 6

• Degeneration + elongation
• Fixed pes planovalgus
• Medial +/- lateral pain
• Too-many-toes sign
• Unable to perform heel raise
• Marked weakness with hindfoot inversion.

Question 7

Aponta algumas características da fase 4 da tendinopatia do tibial posterior.

Answer 7

• Degeneration + elongation
• Fixed pes planovalgus
• Medial +/- lateral pain
• Too-many-toes sign
• Unable to perform heel raise
• Marked weakness with hindfoot inversion
• Pain/crepitus with tibiotalar motion.

Question 8

What two characteristics help to diagnose posterior tibialis dysfunction?

Answer 8

Medial pain or swelling behind the medial malleoli AND change in foot shape (SN 100).