Clinical Review

Tibialis posterior dysfunction: a common and treatable cause of adult acquired flatfoot

BMJ 2004; 329 doi: 10.1136/bmj.329.7478.1328 (Published 2 December 2004)
Cite this as: BMJ 2004;329:1328

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  1. Julie Kohls-Gatzoulis (gatzoulis@ntlworld.com), specialist registrar orthopaedic and trauma surgery1,
  2. John C Angel, consultant orthopaedic surgeon1,
  3. Dishan Singh, consultant orthopaedic surgeon1,
  4. Fares Haddad, consultant orthopaedic surgeon2,
  5. Julian Livingstone, podiatrist3,
  6. Greg Berry, consultant orthopaedic surgeon4
  1. 1 Royal National Orthopaedic Hospital, Stanmore HA7 4LP
  2. 2 Middlesex Hospital, London W1N 8AA
  3. 3 Barnet General Hospital, Barnet EN5 3DJ
  4. 4 McGill University Health Centre, Hôpital Général de Montréal 1650, Avenue Cedar, Montreal, Canada H3G 1A4
  1. Correspondence to: J Kohls-Gatzoulis
  • Accepted 14 September 2004

Introduction

Adults with an acquired flatfoot deformity may present not with foot deformity but almost uniformly with medial foot pain and decreased function of the affected foot (for a list of causes of an acquired flatfoot deformity in adults, see box 1).1 Patients whose acquired flatfoot is associated with a more generalised medical problem tend to receive their diagnosis and are referred appropriately. However, in patients whose “adult acquired flatfoot deformity” is a result of damage to the structures supporting the medial longitudinal arch, the diagnosis is often not made early.2 These patients are often otherwise healthier and tend to be relatively more affected by the loss of function resulting from an acquired flatfoot deformity. The most common cause of an acquired flatfoot deformity in an otherwise healthy adult is dysfunction of the tibialis posterior tendon, and this review provides an outline to its diagnosis and treatment.

Sources and selection criteria

We seached PubMed for publications by using the keywords “flatfoot” and “tibialis posterior dysfunction”.

Tibialis posterior dysfunction: a common condition

Tibialis posterior dysfunction is well recognised by orthopaedic surgeons specialising in foot and ankle surgery and by podiatrists. However, greater general awareness of this condition is required,2 as most patients presenting to a general practitioner receive a diagnosis of ankle sprain or arthritis. By the time most patients present to a specialist foot and ankle clinic they have had the condition for several years and have consulted numerous doctors.3 Even general orthopaedic surgeons and physiotherapists often miss the diagnosis.3 However, tibialis posterior dysfunction need not remain a “specialist diagnosis” as it is usually diagnosed without any investigations, from a history and physical examination.2 Many patients benefit from relatively simple treatment, such as orthotic devices.4 Population based studies to identify the prevalence of tibialis posterior dysfunction are under way. In elderly people the condition …

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