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