- This is a chronic foot condition where the soft-tissues (including the posterior tibial tendon, deltoid and spring ligaments) on the medial aspect of the ankle are subject to repetitive load during walking and standing.
- This condition is typically associated with a progressive flatfoot deformity.
- Both the inside and outside of the ankle can become painful resulting significant disability and deformity.
- History of longstanding pain medial aspect of the foot and ankle resulting in a progressive, painful flatfeet.
- Walk with a limp.
- Worsening of their flatfoot deformity.
- Grade 1 – tenosynovitis, no deformity. Able to single leg heel raise.
- Grade 2 – flatfoot deformity, “too many toes sign” (forefoot abduction), mild sinus tarsi pain. Unable to single leg heel raise.
- Grade 3 –rigid valgushindfoot, rigid forefoot abduction, severe sinus tarsi pain, arch collapse and subtalar arthritis.
- Grade 4 – deltoid ligament compromise, fixed deformity with severe pain.
Tests and Imaging
- Physical examination and history taking.
- Single leg heel raise test.
- Weightbearing X-Rays of the foot to assess the extent of the flatfoot deformity.
- Ultrasound or MRI to identify tendon damage.
- Immediate immobilisation with cam walker.
- Grade 1 and 2 may be correctable with prompt immobilisation followed by appropriate bracing, orthoses and footwear.
- Advise activity modification to avoid exacerbating activities.
- Advise weight loss if indicated.
- Podiatry for immobilisation, insoles, orthoses, bracing, cam walker, footwear advice. Rehab with high repetition, low resistance strengthening program.
- Foot and ankle surgery such as medializing calcaneal osteotomy, or subtalar arthrodesis for those who fail conservative management.