Tibialis Posterior Dysfunction
Another big medical term!
Firstly, let’s talk about the anatomy of the area we will be talking about. Throughout the body tendons role is to attach the muscle to the bone. This is no different in the case of the posterior tibial tendon. The tendon originates from the calf muscle going under the foot attaching medially (inside, its function to maintain the arch of the foot whilst stabilising the ankle throughout the walking cycle.
If you are a runner or play in a sport that requires repetitive impact of the foot then you are exposing your TPT to high volumes of stress that over time could cause it to tear. If the tendon is torn and you continue to play or use it without medical assistance, it will eventually collapse. You may be at higher risk of tibialis posterior dysfunction if you are an aging athlete, 40+ years or a female athlete, if you are diabetic or have been diagnosed with hypertension.
Clinically significant observations of tibialis dysfunction include a change in the shape of the foot, the heel may be tilted outward with the arch collapsed. Due to the foots deformity when observing the foot, you will see “too many toes” due to the direction the foot is in. Generally, you should only see the 5 toe however with severe cases due to the angle of the foot the big toe may be in view.
Treatment of tibialis posterior dysfunction is focused on immobilisation, bracing, orthotics, physical therapy and steroid injections. Immobilisation utilises a leg cast or walking boot for a period of 6-8 weeks, although this is only for severe cases in which other treatment are unable to work. Using a leg brace will cause the stabilising muscles in the leg to atrophy which is a decrease in muscle mass and strength. Less invasive measures include orthotics which are beneficial in most circumstances, the orthotic will assist in the flatness of the foot and redistribution of forces during walking or running. Custom Leather braces are also beneficial to decrease the load on the tendon and assist in patients with flat feet. Both types of treatment should help reduce the need for surgery. After a rest period which will be defined by your health practitioner exercise should be prescribed to rehabilitate the posterior tibial tendon and surrounding musculature. It is important to get this right as appropriate physical rehabilitation is shown to significantly reduce the likelihood of recurrence or a secondary injury occurring due to the deconditioning of the body after injury.
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