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Stage 1: Tendon is intact, but damaged. Stage 2: Tendon has ruptured. Foot begins to deform. Stage 3: The foot is significantly deformed. Cartilage begins to degenerate. Stage 4: Ankle joint begins to degenerate. [1] In early stages, patients will describe foot and ankle pain. Swelling will also be present.
The tendon also can become inflamed, causing a painful condition called posterior tibial tendonitis or posterior tibial tendon dysfunction, according to the Cleveland Clinic.
The tibialis posterior has a major role in supporting the medial arch of the foot. Dysfunction of the tibialis posterior, including rupture of the tibialis posterior tendon, can lead to flat feet in adults, as well as a valgus deformity due to unopposed eversion when inversion is lost. [4] [5]
Accessory navicular bone may cause a continuous stretch and stress on the tibialis posterior tendon which can progress to chronic disabling pain and may cause tendon rupture or secondary flat foot deformity; when this occurs this condition is commonly known as accessory navicular syndrome. [4]
If non-invasive treatment measures fail, tarsal tunnel release surgery may be recommended. Tarsal tunnel release is a form of a nerve decompression to relieve pressure on the tibial nerve. The incision is made behind the ankle bone and then down towards but not as far as the bottom of foot. The posterior tibial nerve is identified above the ankle.
The flexor hallucis longus is situated on the fibular side of the leg. It arises from the inferior two-thirds of the posterior surface of the body of the fibula, with the exception of 2.5 cm at its lowest part; from the lower part of the interosseous membrane; from an intermuscular septum between it and the peroneus muscles, laterally, and from the fascia covering the tibialis posterior, medially.
A tendon transfer is a surgical process in which the insertion of a tendon is moved, but the origin remains in the same location. Tendon transfer involves redistribution of muscle power, not recreation. Tendons are transferred at the distal attachment from lesser to more important functions so that the overall function is improved.
More rarely, excessive physical activity and other forms of foot trauma/chronic ankle injury are thought to be the cause. [1] [6] In the case of posterior tibial tendon dysfunction causing flatfoot, sinus tarsi syndrome can also develop due to the disruption in the entire structure of the foot. [4]
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