Posterior Tibial Tendon Anatomy

Anatomy:

The posterior tibial tendon is the extension of the posterior tibial muscle that lies deep to the calf. The origin of the posterior tibial muscle is the posterior aspect of both the tibia and fibula and the interosseus membrane. The insertion of the posterior tibial muscle is the medial navicular where the tendon divides into nine different insertion site on the bottom of the foot.

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Biomechanics:

The function of the posterior tibial tendon is to plantarflex the foot at the toe off phase of the gait cycle and to stabilize the medial arch and subtalar joint as the body passes over the foot.

Symptoms:

The symptoms of stage I PTTD include a dull ache of the medial arch. The pain become worse with activity, better on days with limited time on the feet. Continued weight bearing activity may result in a partial rupture of the tendon, moving to stage II. Stage I typically show no swelling but presents with pain along the course of the PT tendon from the medial ankle to the insertion of the PT tendon on the medial arch.

Stage II symptoms are persistent and only partially relieved by rest. Pain is present at the onset of weight bearing and continues throughout the day. Some limitation of the ability to raise up on the toes will be present and limited by pain. Mild swelling may be present in the medial arch.

Stage III symptoms are severe with an inability to complete most normal daily activities. Collapse of the medial arch will be obvious. Abduction of the forefoot will show 'too many toes sign'. Patients are unable raise up on their toes.