Medial Ankle Pain/ Tibialis Posterior Dysfunction (TPD)

Pathway

Clinical signs and symptoms

Patient Will

• complain of pain around medial malleolus which is often spontaneous at onset.
• struggle to perform a single leg heel raise

Patient May

• have simultaneous change in foot shape.
• have obvious hindfoot valgus (deviation of Achilles Tendon towards midline) and “too many toes” sign at lateral border of foot.
• be locally swollen posterior/inferior to medial malleolus and tender on palpation of tibialis posterior tendon.

Clinical Test – Heel raise

Ask patient to perform a heel raise on each leg – try for 8 to 10 repetitions.

• A patient without TPD should be able to do this without pain.
• A patient with TPD will struggle.

References/ Further reading

• Kohls-Gazoulis J et al Tibialis posterior Dysfunction: a common and treatable cause of adult acquired flatfoot BMJ 2004; 329: 1328-33
• Kulig K et al Nonsurgical management of Posterior Tibial Tendon Dysfunction with Orthoses and Resistive Exercise: A Randomised Controlled Trial Physical Therapy 2009; 89: 26-37                                                                                                

Assessment video