Anatomy, pathophysiology and classification of posterior tibial tendon dysfunction

Area of Science:

• Orthopedics
• Podiatry
• Biomedical Engineering

Background:

• Adult acquired flatfoot deformity involves medial longitudinal arch collapse and posterior tibial tendon (PTT) weakening.
• PTT dysfunction or rupture, often linked to arthritis or trauma, is a common cause.
• Tendon degeneration in PTT dysfunction may stem from various factors like trauma, anatomy, mechanics, inflammation, and ischemia.

Purpose of the Study:

• To review the anatomy, pathophysiology, and classifications of posterior tibial tendon dysfunction.
• To explore the relationship between PTT vascularization and degenerative disorders.
• To elucidate the mechanisms linking PTT dysfunction to acquired flatfoot deformity.

Main Methods:

• Literature review and analysis of anatomical and pathophysiological data.
• Examination of existing classifications for posterior tibial tendon dysfunction.
• Overview of studies investigating tendon degeneration causes.

Main Results:

• Anatomical features, particularly vascularization, predispose the PTT to degeneration and rupture.
• A literature overview indicated that reduced blood supply to the PTT, especially behind the medial malleolus, is associated with dysfunction and rupture.
• Low PTT blood supply leads to dysfunction and abnormal foot loading.

Conclusions:

• Reduced PTT vascularization is a key factor in PTT dysfunction and rupture.
• PTT dysfunction causes abnormal foot loading, potentially leading to acquired flatfoot deformity.
• Acquired flatfoot deformity might also be a contributing factor to the development of PTT dysfunction.