8. CAUSES OF TIB. POST DYSFUNCTION
• DEGANERATIVE
• INFLAMMATORY:R.A.,SERONEGATIV
E SPONDYLOARTHROPATHY
• TRAUMATIC
9. PATHOPHYSIOLOGY
SUPPORT OF MEDIAL LONGITUDINAL ARCH:
1)STATIC (PLANTAR FASCIA,LONG AND
SHORT PLANTAR LIGAMENT,SPRING
LIGAMENT
2)DYNAMIC(TIBIALIS POST.WHICH CAUSES
INVERSION OF MIDFOOT AND ELEVATION
OF ARCH AND INDIRECTLYHINDFOOT
INVERSION)
10. CLINICAL PRESENTATION
• PAIN AND SWELLING IN MEDIAL ANKLE AND
MIDFOOT DURING WEIGHTBEARING
• LOSS OF ARCH
• TENDENCY TO WALK ON INNERBORDER OF FOOT
• LIMP
• LOSS OF POSTURALSTRENGTH DURING GAIT
• PAINFUL IMPINGEMENT BEETWEEN LATERAL
ANKLE AND FIBULA
• ABNORMAL WEAR OF MEDIAL HEEL AND
INNERBORDER OF SHOE
11. SIGNS
• EXAMINATION IN STANDING POSITION WITH
BOTH FOOT COMPARED
• EARLY STAGE, SWELLING ALONG POST. TIBIAL
TENDON SEEN
• ARCH IS LOWERED
• FOREFOOT IS ABDUCTED
15. OTHER EXAMS
• TENDOACHILLES CONTRACTURE
SHOULD BE LOOKED FOR IN KNEE
FLEXION AND EXTENSION
• LOOK FOR TENDERNESS &
IMPINGEMENT AT SINUS TARSI AND
DISTAL FIBULAR AREA
19. Stages of PTT dysfunction
STAGE1:
• PERITENDINITIS AND TENDON
DEGENERATION
• TENDON LENGTH NORMAL
• PAIN & SWELLING ALONG TENDON
SHEATH
20. STAGE 2
• LENGTHENING OF PTT
• CORRECTIBLE FLAT FOOT
DEFORMITY
• DEFORMITY ON WEIGHTBEARING
• HINDFOOT AND MIDFOOT
DEFORMITY CAN BE PASSIVELY
CORRECTED TO NEUTRAL
