FLAT FEET

FLAT FEET (PES PLANOVALGUS)

Posterior tibial tendon dysfunction is a family of conditions that begin with the tendon on the inside or medial portion of the ankle. Mild cases may be notable only for pain and swelling along the tendon, but more severe cases lead to collapse of the arch of the foot and difficulty rising to a tiptoe position.

The posterior tibial tendon is the major inverter of the foot, which assists with side-to-side motion of the foot. Therefore, when it is weak or injured, balance can become difficult, especially when walking on banked or uneven surfaces.

FLAT FEET

Risk factors for this condition include overuse, cutting sports such as basketball, tennis, or soccer, obesity, diabetes, hypertension, prior trauma or surgery, inflammatory arthritis, and pre-existing flatfeet.

Risk factors for this condition include overuse, cutting sports such as basketball, tennis, or soccer, obesity, diabetes, hypertension, prior trauma or surgery, inflammatory arthritis, and pre-existing flatfeet.

DIAGNOSIS

The first step in diagnosis is appropriate imaging (weight-bearing x-rays of the foot and ankle) and a thorough physical examination. If there is suspicion for a tear of the posterior tibial tendon, an MRI will be ordered.

TREATMENT

Immobilization
If the pain is so severe that walking is difficult, a short use of a camboot or walking cast to fully immobilize the foot and ankle will be necessary.

Orthotics
Offloading the medial ankle by use of arch support can be helpful over time.

Anti-inflammatories
NSAIDs should be taken around the clock for two to three weeks for anti – inflammatory dosing. Speak to your physician if you have concerns about whether anti-inflammatories are safe for you.

Ice
Only use ice if you have no numbness in your feet. If you have any neuropathy, ice application may not be safe. Set the ice pack on the floor and place a dry washcloth on top. Then, set your foot on the ice pack. Ice for up to twenty minutes at a time, and be sure to wait an hour if you are going to repeat the ice application.

Physical Therapy
Physical therapy is not expected to change the shape of the foot or to repair tears. It works to improve strength and balance, and stretch the muscles that tighten over time due to the injury. It can also address the inflammation. Many people improve significantly with physical therapy and never go on to need surgery

Surgery
The surgery required for severe posterior tibial tendinitis requires both addressing the inflammation and damage to the tendon by removal of the tendon and borrowing the tendon to the toes in its place, as well as addressing the flat foot, which requires bony cuts to reshape and reconstruct the arch.

Sometimes the soft tissues are insufficient and fusion of three joints of the hindfoot is required to prevent any motion.

Summary of Treatment

  • Rest/immobilization
  • Ice
  • Oral anti-inflammatories
  • Orthotics
  • Physical therapy
  • Surgery

Treatments to avoid

Do not immediately get injections or surgery for posterior tibial tendinitis. Injections should be avoided altogether to prevent rupture of the posterior tibial tendon, which cannot be repaired once ruptured. Oral steroids are not recommended as first-line treatment of plantar fasciitis because of the systemic risks; there are more specific treatment options in most cases.

Seek attention from a specialist if you are concerned that the pain is worsening, or if is not responsive to these treatments. Other sources of ankle pain should be ruled out.

REFERENCES

“Progressive Flatfoot (Posterior Tibial Tendon Dysfunction.”
https://www.ncbi.nlm.nih.gov/books/NBK542160/

“Posterior tibial tendon dysfunction.”
https://orthoinfo.aaos.org/en/diseases–conditions/posterior-tibial-tendon-dysfunction/

For more information, please visit
https://www.alexisedixonmd.com/

WHAT THEY SAY ABOUT US

★ ★ ★ ★ ★

SAVED MY FOOT!!! I broke my navicular bone and needed a surgery. After seeing a couple of specialists I was referred to see Dr. Dixon and couldn’t be happier that I did. Dr. Dixon and her assistant, Amanda, took really good care of me. After the initial visit, my surgery was promptly scheduled within a week. The surgery went well, I got some screws installed in my bone, and few stitches. My recovery went accordingly as expected, everything healed nicely and the scar is fading away day by day. Alexis Dixon is truly a talented doctor and a great surgeon, not to mention that she is friendly and kind, I highly recommend her for anyone who’s seeking help. Additionally, Amanda is very sweet, attentive, and extremely responsive handling any documentations and couldn’t make it any easier during such a challenging time. THANK YOU SO MUCH FOR SAVING MY FOOT!!!! GRATITUDE!!!!

Mila F.

★ ★ ★ ★ ★

My wife and I have been patients of Dr. Dixon’s since 2017. She has treated or advised us on a variety of foot and ankle issues and treated my wife after she was hit by a car resulting in five fractures in one of her feet. In each of our experiences with Dr. Dixon, we’ve encountered the following: Dr. Dixon is direct, patient with explanations, and thorough in her approach and examination. She listens carefully to our complaints and concerns. She is friendly. She is kind. She provides excellent care. Scheduling appointments is easy. Appointments themselves are prompt. Since we’ve seen Dr. Dixon, she has had two medical assistants: Amanda, until recently, and now Ryann. Both have been friendly, helpful and knowledgeable. The staff at D.I.S.C. is always pleasant and helpful. The radiologist is a truly nice man. Dr. Dixon’s office is relatively far from where we live. It is a testament to the treatment we’ve received that we never consider finding an alternative.

Sam U.