What Is Posterior Tibial Insufficiency?

Posterior tibial insufficiency is a foot disorder where the arch is flattened and the ankle becomes unstable. This condition is a common cause of flatfoot deformities in adults, and there are a number of treatment options available. Patients may opt to see a foot and ankle specialist or a podiatrist to access to the best information about posterior tibial insufficiency treatment. Several weeks or months may be required to address the condition and restore function in the foot.

The posterior tibial tendon, which runs down the back of the leg, through the ankle, and into the middle of the foot, weakens in patients with this condition. It may grow overstretched and inflamed. As the arch loses its support, it begins to flatten, and the bones of the foot can move out of position. The flattened arch allows the foot to splay and the ankle to roll. A doctor may be able to diagnose posterior tibial insufficiency simply by looking at the appearance of the foot when a patient stands on a flat surface.

Pain and soreness can develop along with the physical changes to the foot. Patients may notice that physical activity is uncomfortable. X-rays of the foot can show the flattened arch and changed bone positions. The doctor can determine the staging of the posterior tibial insufficiency on the basis of the extent of the damage and how much flexibility remains in the foot. Stages between one and four, with four being the most severe, can be assigned to the condition.

Older women are more likely to develop posterior tibial insufficiency, as are obese patients and people with high blood pressure. Chronic inflammatory conditions can contribute to or exacerbate this condition, as they may cause irritation in the tendon. Athletes are also at risk, as they may stretch and strain the tendon during training and competition. For athletes, measures like warming up and cooling down well before sports can decrease the risk of developing injuries, as can resting at the first sign of injury.

Conservative treatment for posterior tibial insufficiency may start with some footwear adjustments to support the arch of the foot and increase comfort. Patients can also complete physical therapy exercises to improve strength and flexibility in the foot. If these measures are not sufficient, surgery may be an option. In a surgical procedure, it may be possible to shorten the tendon, add pins to stabilize bones, and take other steps to address the issue.