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The position of the tendon is also thought to contribute, as it makes a sharp turn around the medial malleolus, putting a lot of tension on the tendon. Other proposed causes include constriction underneath the flexor retinaculum , talus abnormalities, osteoarthritis , and preexisting flatfoot . [ 2 ]
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 tibialis posterior muscle originates on the inner posterior border of the fibula laterally. [2] It is also attached to the interosseous membrane medially, which attaches to the tibia and fibula. [2] The tendon of the tibialis posterior muscle (sometimes called the posterior tibial tendon) descends posterior to the medial malleolus. [2]
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 ] The condition is also thought to be caused by ankle/subtalar joint instability causing inflammation in the area.
Knee MRIs should be avoided for knee pain without symptoms or effusion, unless there are non-successful results from a functional rehabilitation program. [ 25 ] In some diagnosis, such as in knee osteoarthritis, magnetic resonance imaging does not prove to be clear for its determination.
The lower leg is divided into four compartments by the interosseous membrane of the leg, the anterior intermuscular septum, the transverse intermuscular septum and the posterior intermuscular septum. [1] Each compartment contains connective tissue, nerves and blood vessels.
Posterior surface of calcaneus via calcaneal tendon: Tibial nerve (S1, S2) Plantarflexes ankle when knee is extended; raises heel during walking; flexes leg at knee joint Plantaris: Inferior end of lateral supracondylar line of femur; oblique popliteal ligament: Weakly assists gastrocnemius in plantarflexing ankle Soleus
[9] [4] One tibial section attaches to soft tissue, 1 cm distal to the joint line. The other tibial section attaches directly to the tibia, anterior to the posteromedial tibial crest, 6 cm distal to the joint line. [2] [9] This distal attachment is the stronger of the two and makes up the floor of the pes anserine bursa.