Tibialis posterior dysfunction

Last revised by Dr Joshua Yap on 19 Jul 2022

Tibialis posterior dysfunction is common, mostly affecting middle-aged and elderly females, and can progress to adult-acquired flatfoot disease

Dysfunction occurs secondary from repetitive overloading resulting in degeneration, which occurs in the typical continuum of tenosynovitis and tendinosis progressing to partial and full-thickness tendon tears. Elongation can also occur without tearing, with as little as 1 cm of elongation resulting in dysfunction 1.

Tibialis posterior can tear in its 1:

  • supramalleolar part (uncommon)
  • retromalleolar part
  • inframalleolar part (most common)

Tibialis posterior dysfunction can be secondary to 3:

  • trauma
  • underlying disease, e.g. inflammatory arthropathy
  • idiopathic
  • functional, e.g. tarsal coalition

Secondary features of tibialis posterior dysfunction include 1:

  • tendon sheath effusion and diameter >7 mm reflects tenosynovitis 1

In advanced posterior tibial tendon injury, increased force is transmitted to other stabilizers of the medial longitudinal arch of the foot. Associations include:

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Cases and figures

  • Case 1: associated flatfoot
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  • Case 2: tenosynovitis
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  • Case 3: tenosynovitis
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