Equinus contracture is also a common finding, which can limit ankle dorsiflexion. Due to the valgus alignment of the foot, you will see flaring out of more than two toes from the lateral hindfoot. While inspecting the patient, one will also commonly see a “too many toes” sign, which is visible when looking from behind the patient. The medial longitudinal arch collapse leads to pes planus, an easily visualized condition. A weight-bearing examination is of importance as a flexible deformity may present normally, while the patient is non-weight bearing. Attention should first be turned to the gross inspection of the feet while standing. A thorough physical examination can help to determine the grading and severity of the disease. At later stages, lateral pain can be seen as well, due to sub-fibular impingement or peroneal tendon injury. The majority of posterior tibial tendon dysfunction patients will demonstrate medial ankle and foot pain, especially in the early stages of the disease. Other potential culprits include constriction beneath the flexor retinaculum, abnormal anatomy of the talus, degenerative changes associated with osteoarthritis, and preexisting pes planus. The adjacent tendons, namely the flexor hallucis longus and the flexor digitorum longus, do not take this sharp turn. This location puts a significant amount of tension on the tendon in the region distal and posterior to the medial malleolus. The anatomic course of the posterior tibial tendon also likely contributes as the tendon does make an acute turn around the medial malleolus. In a study by Manske et al., cadaver specimens showed a region of decreased blood supply from 2.2 +/- 0.8cm proximal to the medial malleolus to a region 0.6 +/- 0.6cm proximal to the medial malleolus. A retromalleolar, hypovascular region does exist and may also contribute to the disease. The most commonly the cause for PTT degeneration is credited to a repetitive loading causing microtrauma and progressive failure. The best ways to prevent, treat tendonitis.Researchers have proposed numerous mechanisms for the degeneration of the posterior tibial tendon (PTT). Achilles tendinopathy: Current concepts about the basic science and clinical treatments. Sprains, strains and other soft-tissue injuries. Extensor hallucis longus tendonitis: a rare cause of dorsal midfoot pain. Flexor hallucis longus (FHL) tendonitis in children and teens.Īmerican Medical Society for Sports Medicine. Posterior tibial tendon dysfunction: an overlooked cause of foot deformity. Posterior tibial tendon dysfunction.īubra PS, Keighley G, Rateesh S, Carmody D. doi:10.1002/jor.22806Īmerican Academy of Orthopaedic Surgeons. Thomopoulos S, Parks WC, Rifkin DB, Derwin KA. Try to keep your foot elevated at about the level of your heart whenever possible, such as while watching television.If it's too loose, it will not provide enough support, and wrapping too tight may hurt and cause harm. Wrap so it fits snug, not too loose or too tight. Compression can bring swelling down and keep the ankle from moving too much. Use a gauze bandage if you are also covering wounds from an injury. Provide compression (or pressure) by applying a gauze bandage, ACE bandage or Coban, or store-bought ankle support.After 72 hours, use 20 minutes of heat, followed by 20 min of ice, and then 20 min of nothing, and repeat as many times as you like. Use a cold compress for 2 minutes at a time for the first 72 hours. While a cold is helpful for swelling, recent medical studies have shown that applying heat to sore areas is equally helpful for soreness.Depending on your condition, it may be okay to walk so long as it doesn't worsen your symptoms. Limit your activity as much as possible.
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