Tibialis Posterior Dysfunction

Patient Information

http://orthoinfo.aaos.org/topic.cfm?topic=a00166

GP Information

Background Information

• Tibialis posterior insufficiency is the most common cause of acquired adult flat foot.
• Patients typically complain of medial ankle / foot pain and weakness with progressive flattening of the foot.
• Examination may reveal a collapsed arch, a hindfoot valgus deformity, tenderness posterior to the medial malleolus and the ‘too many toes’ sign.

Investigation Guidelines

• An USS investigation is indicated in cases of suspected tibialis posterior dysfunction.

Management Recommendations

Conservative measures include

• PRICE
• NSAIDs
• Avoid activities that exacerbate symptoms.
• Patient education.
• Shoe wear advice – avoid totally flat, high, or tight shoes. Trainers are appropriate.
• OTC orthotics if flat footed with medial arch. This may reduce the stretch on the tendon.

Referral Indications;

• Diagnostic uncertainty.
• Recent or worsening flat foot deformity.
• Failure of conservative measures after a minimum of 6 weeks.
• Results of diagnostics indicate specialist assessment required.