| Having flat feet is a common condition with | | | | of posterior tibial tenodonopathy. While the |
| about 25 percent of the population having | | | | diagnosis may be suspected on clinical |
| this disorder. The medical term for flat foot | | | | grounds, diagnostic ultrasound or magnetic |
| is "pes planus." Contrary to popular belief | | | | resonance imaging (MRI) should be done to |
| though, having flat feet is a potentially | | | | better assess the condition of the tendon. |
| serious problem. It has been associated with | | | | Early diagnosis is important to staging |
| plantar fasciitis (inflammation of the soft | | | | treatment and improving prognosis. The danger |
| tissue of the bottom of the heel), Achilles | | | | accompanying posterior tibial tendonopathy is |
| tendonitis, painful shin splints and | | | | the high probability of tendon rupture |
| osteoarthritis of the knee. While most people | | | | occurring over time. Vigilance must be |
| with flat feet probably have a genetic | | | | maintained. Patients should be told about the |
| predisposition towards this, some people have | | | | danger of tendon rupture and the need to |
| "acquired" flat feet... in other words, they | | | | remain compliant with therapy If there is an |
| develop it over time. The most common cause | | | | underlying form of inflammatory arthritis, it |
| of acquired flat foot in an adult patient is | | | | must be optimally controlled with medication. |
| posterior tibial tendonopathy (tendonitis). | | | | The joint should be stabilized with devices |
| While posterior tibial tendonopathy is a | | | | such as orthoses, braces, and casts. |
| common disorder, it is often overlooked. | | | | Therapeutic taping can also be used with |
| So... what are some of the factors that might | | | | early disease. An orthopedic foot and ankle |
| cause posterior tibial tendonopathy? Often, a | | | | specialist should be consulted. Steroid |
| flat foot will develop over time following an | | | | injection into the tendon sheath along with |
| injury to the ankle. Patients may be | | | | bracing can be done if there is severe pain |
| overweight. A typical scenario is a | | | | but it should be remembered that steroids may |
| middle-aged person who suddenly increases | | | | weaken the tendon leading to the possibility |
| their activity level. It is a common disorder | | | | of subsequent tendon rupture. If the problem |
| in runners and hikers. Signs and symptoms | | | | is diagnosed early, intensive physical |
| include: - Pain and swelling of the inside | | | | therapy can be helpful. In cases where the |
| part of the ankle extending down into the | | | | tendonopathy is advanced or where there is |
| arch of the foot - The patient may be unable | | | | already rupture, surgical intervention is |
| to invert (turn in) their foot or lift up on | | | | required. Surgical procedures include |
| their heel while standing. - On examination, | | | | debridement of the tendon, tendon transfer, |
| there may be pain with palpation (pressure) | | | | and possibly ankle fusion. Flat foot is not a |
| along the course of the tendon, behind and | | | | benign process and should be investigated |
| below the inside bump of the ankle. Pain can | | | | sooner rather than later. |
| be provoked if the patient is asked to turn | | | | |
| the foot in against resistance. While | | | | Nathan Wei, MD FACP FACR is a rheumatologist |
| posterior tibial tendonopathy can present in | | | | and Director of the Arthritis and |
| one foot only, about three-quarters of the | | | | Osteoporosis Center of Maryland. He is a |
| time it may be present in both feet. | | | | Clinical Assistant Professor of Medicine at |
| Inflammatory forms of arthritis, particularly | | | | the University of Maryland School of |
| rheumatoid arthritis, are a very common cause | | | | Medicine. |