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Acquired flatfoot in adults due to dysfunction of the posterior tibial tendon.

Dysfunction of the posterior tibial tendon is increasingly recognized as an etiology leading to acquired flatfoot in adults. Increased awareness of this condition during the past fifteen years has resulted in intensive study of the basic science and pathophysiology behind this clinical syndrome. New regimens for clinical assessment and treatment have been developed. Although much progress has been made in the recognition and treatment of this condition, many controversies and unanswered questions remain. This article will review the current thinking with regard to the pathophysiology, clinical evaluation, and decision-making process for the treatment of this common, debilitating condition.

Kulowski, in 1936, was the first, to our knowledge, to describe tenosynovitis of the posterior tibial tendon39. Almost twenty years later, Fowler discussed tibialis posterior syndrome and described a series of patients who had had operative treatment of that condition19. In 1963, Williams described the operative treatment of tenovaginitis of the posterior tibial tendon73. In 1969, Kettelkamp and Alexander reported on repair of spontaneous rupture of the posterior tibial tendon35.

Little else was written regarding the problems emanating from dysfunction of the posterior tibial tendon until others rekindled interest in this subject during the 1980s28,32,33,44-46. Many authors have described the progressive nature of acquired flatfoot that occurs following the onset of dysfunction of the posterior tibial tendon in an adult4,9,12,20,22,26,27, and a multitude of treatment regimens have been reported2,5,7,8,13,15,19,21,23,25,28,30,32,35,38,40,46,48,52,57,58 …