Noticed Your Feet Getting Flatter?

The tibialis posterior, is a muscle found in the lower leg wrapping around the inside of the ankle and inserts into the medial aspect or the inside of the foot. It is one of three playing vital roles in postural stability, shock absorption and the structural integrity of the foot. Weakness in this muscle and its reduced ability to carry out its role,  is referred to as “Post Tib Disfunction”.

On occasion “Tib Post” may be congenitally absent, injured, ruptured, torn or plain old ‘overused’. The difficulty is that like a drowning victim, without help the situation predictable gets worse and ends in failure. Thus the urgent need for early detection and  identification to determine the source and extent of the injury. Without knowing the cause and extent we cannot advise an appropriate treatment plan.

Arriving in our offices the patients’ typically pinpoint the insertion of the tibialis posterior tendon as the focus of pain,  and the exact path of the tendon on the medial ankle or the generalized medial ankle and inside of the foot. Sometimes however they will be without pain and simply identify they have very flat feet or notice it has flattened over time.

Over the last 10 years we have seen a dramatic increase in juvenile and teenage cases of Post tib disfunction, often times in generally; healthy, average weight, well nourished, and active individuals. I mention the weight factor to illustrate that while yes obesity most certainly will be an additional complicating factor, it is not an identifiable cause for many in this group.

Physical examination, history taking and video gait analysis form the mainstay of identifying the condition.  The following image is of one of the simple tests we perform on potential cases where we ask the patient to stand on one foot while stabilized and rise up slowly onto the ball of the foot, for some this will be impossible or very challenging.

Treatment is often multifaceted with footwear advice and functional orthotic intervention being the essential components. Fortunately our clinical partners at Integrity Orthotics have come to our aid developing a custom orthotic devices capable of delivering the significant functional support these individuals require and doing so in a manner that is appropriate to the stage of development and severity of the disorder.

Many new clients suffering from this condition have sought treatment previously, arriving with collections of orthotics often times causing severe arch pain to be tolerable, or too soft rendering them completely ineffective.

To summarize, this condition is progressive and debilitating, reducing quality of life and affecting mental and physical well-being. The earlier a diagnosis is made, the more destruction and adaptation can be prevented.

Schedule an appointment at an office location near you with one of our dedicated specialists. We do not require a referral however pertinent information from your primary care specialist may help in our diagnosis. Bring any pertinent images (X-rays) or test results with you and if appropriate samples of your footwear. Given the nature of our specialty it is likely we will want to observe you standing or walking during the initial exam. Call The Podiatry Associates in Mississauga, at (905)568-3800. We are also located in Brantford, ON, at (519) 751-2900 and Whitby, Ontario, at (905) 433-0200