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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.
Pain radiating up into the leg, [1] behind the shin, and down into the arch, heel, and toes; Hot and cold sensations in the feet; A feeling as though the feet do not have enough padding; Pain while operating automobiles; Pain along the posterior tibial nerve path; Burning sensation on the bottom of foot that radiates upward reaching the knee
It involves inflammation or tearing of the posterior tibial tendon, which connects the calf muscle to the bones on the inside of the foot. It plays a vital role in supporting the arch and assisting in foot movement. This condition can cause pain, swelling, and potentially lead to flatfoot if left untreated. [1]
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]
The tibial nerve, posterior tibial artery, posterior tibial vein, and flexor tendons travel in a bundle along this pathway through the tarsal tunnel, in the following order from anteromedial to posterolateral: Tibialis posterior tendon. [2] Flexor digitorum longus tendon. [2] Posterior tibial artery. [2] Posterior tibial vein. [1] Tibial nerve. [2]
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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