Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Tibialis Posterior Syndrome

SYMPTOMS

Gradually increasing exercise-induced pain around the posterior medial part of the ankle joint, often after previous sprain. It is common in middle-aged or elderly athletes.

AETIOLOGY

This is a tenosynovitis and or partial rupture of the posterior tibial tendon. If the tendon ruptures completely, a fairly discrete acquired flat foot can result after a long time of diffuse symptoms.

CLINICAL FINDINGS

There is tenderness on palpation over the posterior tibial tendon.

INVESTIGATIONS

MRI or ultrasound may show localised oedema or swelling around the tendon. Sometimes a rupture can be seen.

TREATMENT

Early proprioceptive training and weight-bearing exercises are usually recommended. Rehabilitation is usually curative and the athlete can resume occasional sport within six to twelve weeks, using well-fitting shoes, with or without orthotics.

REFERRALS

Refer to Dr Kevin Yip,  orthopaedic surgeon if pain is unclear or severe.

EXERCISE PRESCRIPTION

Rest will not help so allow all kinds of sporting activities using well-fitting shoes and avoiding impact. Suggest low-impact activities such as cycling and swimming.

EVALUATION OF TREATMENT OUTCOMES

Monitor decrease of clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

Stress fracture of the navicular bone (X-ray or MRI will differentiate).

PROGNOSIS

Excellent-Good but in rare cases an acquired flat foot can occur, requiring permanent orthotics in shoes.

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