Posterior tibial tendon insufficiency. Its Diagnosis, Management, and Treatment.

Posterior tibial tendon dysfunction, once thought to be a rare clinical entity, has been observed to be a major cause of acquired flatfoot deformity in adults. Several risk factors have been identified, ranging from inflammatory conditions to obesity. A physical examination using a series of tests, including the single-limb rise, first-metatarsal rise sign, and the "too-many-toes" sign, used in combination with selected radiographic imaging techniques, allows classification of the severity of disease. This staging system then serves as the basis for formulating the treatment options, which include nonoperative as well as operative alternatives. Conservative treatment involves rest, anti-inflammatory medication, orthotic devices, and modifications to shoes. Operative options are numerous and include primary tendon repair, tendon transfer, osteotomies, and arthrodesis.