Posterior tibial dysfunction

The posterior tibial dysfunction is a serious disease of the tendon of the tibialis posterior in the lower leg-foot area. As damage to the tibialis posterior tendon progresses, an increasing dysfunction is produced. In the further course of the disease, this leads, in most cases, to a Planovalgus deformity ( flat foot ).

causes

Aetiologically , the dysfunction has not yet been fully clarified. It is clear, however, that the damage to the tibialis posterior tendon has almost exclusively a degenerative background and occurs three times more frequently in women than in men. Overweight and hypertension have a positive effect on the disease .

Diagnosis

The pathology of the disease is documented with the help of sonography and MRI . The severity of the misalignment can be determined by means of the x-ray diagnosis . In the next step, the functional disorder of the foot is determined with the help of muscle strength testing and clinical function tests. Since the tibialis posterior dysfunction is a stage disease, it is then, according to Johnson & Strom (1989), divided into one of the three phases depending on the course of the disease. Newer diagnostic approaches include pedobarography to analyze the gait pattern in order to be able to determine the division into the respective stage as precisely as possible.

Conservative treatment

Despite the progressive course of the disease, conservative treatment is usually the appropriate approach initially. The basis of conservative treatment is to protect the foot, loads should only be applied if they are painless. In further steps, physiotherapeutic measures and systemic anti- inflammatory therapy are usually recommended. The passive support of the longitudinal arch of the foot by means of insoles is also useful, which especially cushion the heel .

Operative treatment

Different operational measures are taken between the three stages after Johnson & Strom 1989. In stage I, surgical exploration is first performed with a skin incision and inflamed tissue is removed. In addition, dead tissue is excised within the tendon using a tenotomy . In stage II, if the course of the disease allows, a tendon transfer is performed. Here, healthy tendons are used to reconstruct diseased tendons. For advanced cases in stage II and stage III, bone interventions in the form of osteotomies are also required. In particularly serious cases, arthrodesis is performed to improve the condition.

literature

• Andreas B. Imhoff, Hans Zollinger-Kies: foot surgery . Georg Thieme Verlag 2004, ISBN 9783131238511 , pp. 192-198.

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !