Tibialis Posterior tendinopathy
Not every “fallen arch” or flat foot is because of a tendon problem, but tendinopathy of the posterior tibial tendon is the most common cause.
This tendon runs around the inner ankle bone and attaches to the navicular bone in the instep. It functions like braces to hold up the arch of the foot. Initially pain and swelling may be noticed because of “tendonitis”, and subsequently weakness leading to difficulty with balance or stairs occurs. Once the arch has collapsed pain may occur under the outer ankle bone, as the heel impinges there.
In the early stages physiotherapy and orthotics to rest and strengthen the tendon are helpful. When surgery is required, the tendon is reconstructed using a neighboring tendon, and the shape of the foot restored by operating on the bones at the same time. In advanced cases the foot is straightened and kept straight by stiffening selected joints. These operations are major undertakings and recovery starts with three months in a plaster cast. A further nine months of physiotherapy and strengthening follows.
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