Tibialis Posterior Dysfunction
- 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.
- An USS investigation is indicated in cases of suspected tibialis posterior dysfunction.
Conservative measures include
- 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.
- 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.