10. BLOOD – MAJOR – POSTERIOR TIBIAL ARTERY
WATERSHED AREA OF TENDON – ABOUT 2.5 - 3 CMS PROXIMAL TO MEDIAL MALLEOLUS
RELATIVE HYPOVASCULAR AREA – PRONE FOR DEGENERATION, POOR HEALING AND TEAR
DEGENERATION – PRIOR TO CLINICAL SYMPTOMS
11. FUNCTIONS
1. PRIMARY DYNAMIC STABILISER OF MEDIAL LONGITUDINAL ARCH
2. MAIN – INVERTER OF SUBTALAR JOINT – MAX at STANCE – gives mechanical advantage to TA.
( The Dynamic stability is complemented by static stability – bony and soft tissues – spring,
talonavicular capsule, plantar fascia and deltoid ligament)
3. ASSISTS PLANTAR FLEXION – ANKLE
13. Synonym - Adult Acquired Flatfoot Deformity
• 1950’S Distinct entity
• Historical treatment background – late surgical arthrodesis
• Now, early diagnosis and limiting progress , to preserve ROM and function.
14. CAUSES –
1. Multifactorial
2. Over use
3. Age related degeneration
4. Traumatic
5. Congenital Pes Planus – greater stresses as patients age, predisposed.
6. Co- morbidities – Obesity, Systemic steroids, DM, Fluoroquinolones, RA, SSA
PATHOLOGY –
1. After tendon injury, local inflammatory
cascade increases local metallo-proteinase
activity and leads to further tendon injury.
15. CLINICAL FEATURES
1. PAIN
2. FATIGUE
3. FLAT FOOT
4. FLAT FOOT
5. TOE MANY TOE SIGN
6. HEEL VALGUS
7. INABILITY TO DO STANCE PHASE
8. ABSENCE OF HEEL INVERSION DURING TOE OFF
9. TENDERNESS, SWELLING , WARMTH
10. PALPABLE DEFECTS IN CONTINUITY
11. SUBTALAR IMPINGEMENT
12. ANKLE AND MIDFOOT ARTHRITIS – JOINTLINE
TENDERNESS
13. MOTOR POWER OF TENDON
14. FINGOMETER
COMAPRE WITH OPPOSITE SIDE !
16.
17. CLASSIFICATION :
1. JOHNSON AND STROM - 2 STAGES –
I. PERITENDINITIS
II. TENDON ELONGATES – SUPPLE FLAT FOOT
III. RIGID FLATFOOT DEFORMITY
2. In 1996, Myerson – added 4 th stage - tilting of ankle joint.
3. Bluman , 2007 , updated – descriptive including treatment recommendations of each stage.
4. Richter , 2013 - only evaluated function of tendon – independently from stiffness of joints