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If physical therapy fails, patients will often be referred for surgery. [1] [2] Surgery procedures become more invasive as the condition progresses. Tenosynovectomy with tubularization; Medial calcaneal osteotomy with posterior tendon debridement and repair; Flexor digitorum tendon (FDL) transfer; Spring ligament reconstruction; Achilles tendon ...
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]
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]
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.
Tendon transfers have higher chance to treat nerve palsy, and such transfers include posterior, anterior, and anteroposterior tibial tendon transfer. Peroneal nerve and its nerve branches need to be fixed from adherence to proximal fibula, which proximal fibula is about 3~5 cm. [ 14 ]
Otherwise repeated physical exams may be sufficient. [2] More recently, the FAST-D protocol, assessing the posterior tibial and dorsalis pedis arteries for a ‘tri-phasic wave pattern’ with ultrasound, has been shown to be reliable in ruling out significant arterial injury. [8]
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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.
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