Tibialis Posterior Dysfunction

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Patient Information

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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.