Posterior Tibial Tendon
The posterior tibial tendon adducts and supinates the forefoot and inverts the sub-talar joint. Dysfunction of the tendon can be classified into three stages.
Stage 1 represents tendonitis. Treatment initially consists of a short period of immobilisation followed by physiotherapy and orthotics. If symptoms persist despite this approach then the tendon can be decompressed and a synovectomy performed.
In Stage 2 disease the tendon dysfunction is associated with a mobile flat foot deformity and in stage three disease the patient develops a fixed flat foot deformity. From a surgical point of view Stage 2 disease can be managed with an FDL transfer and medial heel shift.
Stage 3 disease often requires some form of fusion either of the sub-talar joint or a triple fusion.