Posterior tibial Tendon dysfunction


  • 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.

Diagnostic tips

  1. History of longstanding pain medial aspect of the foot and ankle resulting in a progressive, painful flatfeet.
  2. Walk with a limp.
  3. Worsening of their flatfoot deformity.
  4. Grade 1 – tenosynovitis, no deformity. Able to single leg heel raise.
  5. Grade 2 – flatfoot deformity, “too many toes sign” (forefoot abduction), mild sinus tarsi pain. Unable to single leg heel raise.
  6. Grade 3 –rigid valgushindfoot, rigid forefoot abduction, severe sinus tarsi pain, arch collapse and subtalar arthritis.
  7. Grade 4 – deltoid ligament compromise, fixed deformity with severe pain.

Tests and Imaging

  1. Physical examination and history taking.
  2. Single leg heel raise test.
  3. Weightbearing X-Rays of the foot to assess the extent of the flatfoot deformity.
  4. Ultrasound or MRI to identify tendon damage.

Immediate Treatment

  1. Immediate immobilisation with cam walker.
  2. Grade 1 and 2 may be correctable with prompt immobilisation followed by appropriate bracing, orthoses and footwear.
  3. Advise activity modification to avoid exacerbating activities.
  4. Advise weight loss if indicated.

Possible Referral

  1. Podiatry for immobilisation, insoles, orthoses, bracing, cam walker, footwear advice. Rehab with high repetition, low resistance strengthening program.
  2. Foot and ankle surgery  such as medializing calcaneal osteotomy, or subtalar arthrodesis for those who fail conservative management.