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  • Posterior tibial tendon dysfunction (PTTD).
  • Ankle arthritis or D.J.D. (Degenerative Joint Disease).
  • Tibialis tendonitis (posterior of anterior).
  • Ankle, subtalor, or midtarsal trauma.
  • Severe pronation or pes planus.
  • Talocalcaneal varus or valgus.
  • Post CVA / Polio Syndrome.
  • Charcot foot deformity.


Posterior Tibial Tendon Dysfunction


This is one of the more common tendon disorders about the ankle. Posterior Tibial Tendon Dysfunction (PTTD) is an alteration of the function of the posterior tibial tendon. This may be due to a rupture, laceration, inflammation, abnormal insertion, or attenuation of the tendon. With dysfunction of the tendon, there can be excessive pronation of the foot and an acquired flatfoot.

Functional Anatomy:

The posterior tibial tendon helps support the arch of the foot and provides power to point the foot down and to turn the foot inward.


Posterior tibial tendon dysfunction is usually pain with walking/standing as well as a noticeable flatting of the foot while walking/standing. There maybe increased shoe irritation in the arch of the foot as the foot is allowed to excessively pronate or roll inward.

Patients often experience tenderness and inflammation along the inner part of the ankle. They note weakness when standing on their toes.

As the disease progresses, patients describe loss of the arch of the foot while standing. Patients often note continued pain and inflammation. The foot tends to turn outward with weight bearing.

Late stage disease includes a flat foot deformity with degenerative changes in the joints below the ankle.

  • Stage I
    Tendon Status:
    Attenuated (lengthened) with tendonitis but no rupture.
    Clinical Findings:
    Palpable pain in the medial arch. Foot is supple, flexible with "too many toes" sign.
    Mild to moderate tenosynovitis on MRI, no X-ray changes.

  • Stage II
    Tendon Status:
    Attenuated with possible partial or complete rupture.
    Clinical Findings:
    Pain in arch. Unable to raise on toes. Too many toes sign present.
    MRI notes tear in tendon. X-ray noting abduction of forefoot, collapse of talo-navicular joint.

  • Stage III
    Tendon Status:
    Severe degeneration with likely rupture.
    Clinical Findings:
    Rigid flatfoot with inability to raise up on toes.
    MRI shows tear in tendon. X-ray noting abduction of forefoot, collapse of talo-navicular joint


Charcot Foot/Charcot Neuropathy:
Treatment and Management

Bracing is a non-invasive form of correcting problems caused by Charcot foot. Often gait abnormalities can be corrected by the use of a total contact ankle brace called the South West Charcot AFO (ankle-foot orthoses). This AFO helps control foot drop and ankle instability with a better sense of balance for patients. The SouthWest Charcot AFO is one of the latest forms of total contact bracing available for Charcot foot patients.

Make-up of the S. W. Charcot AFO:

Symptoms of Charcot foot:

  • Redness
  • Strong pulse
  • Instability of the joint
  • Dislocation of the joint
  • Insensitivity in the foot
  • Subluxation (misalignment of the bones that form a joint)
  • Swelling of the foot and ankle (caused by synovial fluid that leaks out of the joint capsule)

Charcot foot affects the metatarsal, tarsometatarsal, and tarsal joints, which are located in the midfoot and forefoot. Charcot foot is a progressive degenerative condition that affects the joints in the feet. It is associated with nerve damage (neuropathy) that decreases the ability to sense stimuli, including pain, and decreases muscular reflexes that control movement. As a result, the joints in the feet are subjected to repeated trauma and injury, causing progressive damage to the ligaments, cartilage, and bones.

Large bony overgrowths, or osteophytes, develop as the body replaces lost bone with new bone and may protrude from the top of the foot. Fractures may cause the tarsal bones to collapse and outward bowing of the arch, or "rocker foot."


Studies of the Charcot Foot

Charcot Foot: The Diagnostic Dilemma

The Charcot Foot: Management of Diabetic Charcot Arthropathy

The Foot: Neuroarthropathy






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