[Dysfunction of the posterior tibial muscle due to tendon insufficiency]

The mechanical integrity of the arch of the foot depends on static and dynamic factors. The posterior tibial tendon in particular is situated to provide dynamic support along the medioplantar aspect of the foot and arch. Tibialis posterior dysfunction is a progressive condition leading to a painful flatfoot deformity. To understand changes that occur in the pathological state, a clear analysis of the normal function of the tibialis posterior is necessary. Early diagnosis of posterior tibialis dysfunction is crucial for preventing a progressive deformity. For diagnosis, clinical findings are predominant. When passive correction of the foot deformity is still possible, a reconstruction of the tendon should be attempted. As retraction of the tendon ends or degeneration prevents primary repair, tendon transfer may substitute for the posterior tibial tendon. When a fixed flatfoot has developed, realignment by arthrodesis is advised. Triple arthrodesis may be appropriate to correct hindfoot valgus as well as forefoot abduction.