Tendons are attached to bones by muscles and stretch the joints, allowing you to manage the joint from side to side. One of the important tendons in the lower leg is the posterior tibial tendon. This tendon begins in the calf, extends downwards to the inside of the back of the ankle, and connects to the bones in the middle of the foot.
The posterior tibial tendon helps lift the arch of the foot and provides support when you lift your foot after stepping on it, when your toes separate while walking. If this tendon becomes inflamed due to excessive stretching or tearing, you may have pain over the inner joint and gradually the internal arch of the sole of the foot disappears, leading to flat feet.
Signs and symptoms of posterior tibial tendon dysfunction:
- Pain and swelling on the inner side of the ankle,
- Disappearance of the foot arch and development of flat feet,
- Slowly developing pins and needles in the foot or on the other side of the ankle,
- Weakness and inability to stand on the toes,
- Tenderness on the midfoot, especially during activity and under pressure.
Risk factors
Posterior tibial tendon dysfunction occurs most often in women over the age of 50, as the tendon may be abnormal from birth. However, there are several other risk factors listed as follows:
- Obesity,
- Diabetes,
- High blood pressure,
- Previous traumas such as fracture of the inner side of the ankle,
- Local steroid injection,
- Inflammatory diseases such as Reiter's syndrome, rheumatoid arthritis, spondylar atropathy and psoriasis.
Athletes who play sports such as basketball, tennis, football or hockey can also tear the posterior tibial tendon. In addition, tendon inflammation develops when excessive force is placed on the foot while running on hilly paths or roads.
Diagnosis:
Diagnosis; It depends on the history and physical examination and both. Your doctor may ask you to stand with your bare feet and move away from him to see how your foot functions are. If the condition is advanced, the front of your affected foot may slide outwards. r. When viewed from behind, it looks as if you have many toes. At the same time, you may be asked to stand on your toes or lift one knee: Stand with your hands on the wall, lift your good foot off the floor, and rise up on your other toes. Normally the heel will turn inward. The absence of this sign indicates posterior tibial dysfunction. Your doctor may request x-rays, ultrasound and magnetic resonance imaging of your foot.
Treatment
If left untreated, the flat feet developed by posterior tibial dysfunction become rigid (hard). Arthritis may develop in the hind foot. The pain increases and spreads to the outside of the ankle. The way you walk may be affected and it may be difficult to put on your shoes. The treatment your doctor will recommend depends on how advanced the condition is. In the early stages, posterior tibial tendon dysfunction; It can be treated with rest, non-steroidal anti-inflammatory medication such as aspirin or ibuprofen, and immobilization of the foot with a rigid knee cast or boot to prevent overuse of the foot for six to eight weeks. After the cast is removed, supports placed inside the shoe, such as a heel wedge, or sole support may be helpful. If the condition is advanced, your doctor may recommend using a conventional ankle-foot orthosis or brace. If conservative treatment is not sufficient, your doctor may recommend surgery. Several surgical methods are often used to treat posterior tibial tendon dysfunction, often more than one at a time. Your doctor will determine a specific course of treatment based on your individual situation. Surgery options include:
- Tenosyevectomy: In this method, the surgeon cleans (debrides) and removes (cuts out) the inflamed tissue surrounding the tendon.
- Osteotomy: This method involves removing the heel bone (calcaneus). ), allows it to get back into order. The surgeon may sometimes need to remove a piece of bone.
- Tendon Transfer: In this method, fibers taken from another tendon (the flexor digitorum longus tendon that bends the toes) are used to repair the damaged posterior tibial tendon.
- Extension of the lateral column: In this method, surgery Ah removes a small, wedge-shaped bone from the patient's hip and places it inside the outer edge of the calcaneus. This process helps realign the bones and recreate the arch.
- Arthrodesis: This method is the joining of one or more bones by welding. (fusion surgery) This surgery stabilizes the hindfoot and prevents further progression.
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