Acquired adult flat foot secondary to posterior tibial-tendon pathology.

TLDR

Posterior tibial tendon dysfunction presents with non‑specific signs that cannot be distinguished preoperatively by clinical or radiographic evaluation. Surgical exploration of 19 patients with posterior tibial tendon dysfunction was performed, with reinsertion for avulsion, flexor tendon transfer for rupture, and synovectomy for in‑continuity tear or tenosynovitis. Four lesion types were identified, and follow‑up revealed that only patients with rupture, in‑continuity tear, or tenosynovitis improved, whereas avulsion cases did not.

Abstract

Nineteen patients with the clinical diagnosis of dysfunction of the posterior tibial tendon underwent surgical exploration. Four types of lesions were identified: avulsion of the tendon at the insertion (Group I), mid-substance rupture of the tendon (Group II), an in-continuity tear of the tendon (Group III), and no tendon tear, tenosynovitis only (Group IV). These conditions could not be separated preoperatively by clinical or radiographic means. The patients in Group I were treated by reinsertion of the tendon; in Group II, by flexor tendon transfer; and in Groups III and IV, by synovectomy. At follow-up, most patients in Group I reported no improvement, but the patients in Groups II, III, and IV showed both subjective and objective improvement. The signs and symptoms of dysfunction of the posterior tibial tendon are not specific for mid-substance ruptures of the tendon but also can occur with avulsions or synovitis, or perhaps from other, as yet undefined lesions.