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Posterior tibial tendon dysfunction (PTTD) is a medical disorder that results in inflammation or tearing of the posterior tibial tendon.The posterior tibial tendon attaches one of the calf muscles to the bones located on the inner foot.Consequently, PTTD causes flatfoot because the tendon is not able to support the arch of the foot.Flatfoot is when the arch of the foot is fallen and the foot points outwards.PTTD is also called adult acquired flatfoot as opposed to congenital flat foot.Doctors can normally treat this disorder without surgery, but sometimes surgery is essential to mend the tendon.IncidencePosterior tibial tendon dysfunction (PTTD) is more frequent in women.It often manifests in the sixth decade.Mechanism:The exact cause of PTTD is not known.It is an acute injury (e.g., ankle fractures caused by pronation and external rotation vs. long-standing tendon degeneration)1. Early diseaseEarly tenosynovitis continues to PTTDIt results in loss of medial longitudinal arch dynamic stabilization2. Late diseasePTTD supplies attritional failure of static hind-foot stabilizers and collapse of the medial longitudinal arch1. Spring ligament complex (e.g., superomedial calcaneonavicular ligament)2. Plantar fascia3. Plantar ligamentsFixed degenerative joint changes happen at late stages1. Foot deformity2. Pes planus3. Hind foot valgus4. Forefoot varus5. Forefoot abductionRisk factors are:1. Obesity2. Hypertension3. Diabetes4. Increased age5. Corticosteroid use6. Seronegative inflammatory disordersFrequent activities that induce an overuse injury are:1. Walking2. Running3. Hiking4. Climbing stairs5. High-impact sportsPTTD tends more to happen in:1. Females2. People over the age of 403. People who are overweight or obese4. Diabetics5. People with hypertensionSymptoms of PTTD are:1. Pain, normally around the inside of the foot and ankle2. Swelling, warmth, and redness along the inside of the foot and ankle3. Pain that worsens during activity4. Flattening of the foot5. Inward rolling of the ankle6. Turning out of the toes and footPhysical examination is by inspection and palpation of the foot1. Pes planus or flat foot is evident2. Collapse of the medial longitudinal arch is present3. Hind foot valgus deformity is seen4. Forefoot abduction is seen in Stage IIB disease5. The "Too many toes" sign is present6. >40% talonavicular uncoverage7. Forefoot varusThe doctor may look for swelling along the posterior tibial tendon.The doctor will also assess the range of motion by moving the foot side to side and up and down.PTTD can provide problems with side-to-side range of motion, and issues with moving the toes toward the shinbone.The doctor will also observe the shape of the foot.They will examine for a collapsed arch and a heel that has shifted outward.The doctor may also assess how many toes they can see from behind the heel when the patient is standing.Normally, only the fifth toe and half of the fourth toe are seen from this angle.MRI and ultrasound scans can verify PTTDMost cases of PTTD are treatable without surgery.1. Reducing Swelling and PainEarly treatment helps decrease pain and swelling and permits the tendon to heel.Applying ice to the sore area and taking non-steroidal anti-inflammatory medications (NSAIDs) can decrease swelling and pain.The doctor will also advise the patient to rest and avoid activities2. Foot SupportDependent on the seriousness of the PTTD, the doctor may indicate some form of support for the foot and ankle.Surgery may be required if the PTTD is serious.FDL transferCalcaneal osteotomyArthrodesisTABLE OF CONTENTChapter 1 Posterior Tibial Tendon DysfunctionChapter 2 CausesChapter 3 SymptomsChapter 4 DiagnosisChapter 5 TreatmentChapter 6 PrognosisChapter 7 Flat FeetChapter 8 Tarsal Tunnel SyndromeEpilogue
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Subtítulo: GUIDE TO THE CONDITION, DIAGNOSIS, TREATMENT AND