Causes and risk factors
Injury is the most common cause of tendon dysfunction. Trauma caused due to fall results in tearing of the tendon. Overuse of the tendon due to repeated activity is another contributing factor. This injury is commonly seen in people who are engaged in sports like basketball, soccer, or tennis. As the tendon becomes inflamed or is torn due to these causes, the support and stability of the arch is hampered resulting in tendon dysfunction.
Clinical presentation:
In most of the cases, unilateral affection is seen, however, in a few cases bilateral affection also occurs. Like any other complaint, pain in the ankle region of the affected foot is one of the main features seen. Dull aching pain is felt. Swelling and tenderness is seen. The area is warm to touch. As the support and stability of the arch is hampered, flat foot occurs. Inward rolling of the ankle occurs. Gradually as the condition progresses, the ankle rolls inwards and the foot and toe is turned outwards. Pain is felt inside the foot and ankle region where the tendon lies along with difficulty in standing for a long time and running. In later stages, pain localizes on the outer side of the ankle.
Investigations:
The symptoms and the history are taken into consideration. A local examination is carried out. Certain physical tests help in confirming the condition. These comprise of “too many toes” sign and single limb heel rise test. In too many toes sign, usually as one looks from behind, the fifth and half of the fourth toe is visible; however, in this condition more of the little toe can be seen. While in limb heel rise test, a person with posterior tibial tendon dysfunction cannot stand on one leg and is unable to raise the heel. In order to confirm the diagnosis, certain investigations are advised. An X-ray of the affected ankle is done. Advanced imaging techniques like MRI and CT scan can also be advised.
Treatment:
As the tendon dysfunction is a progressive condition, early diagnosis and treatment is important. The treatment plan comprises of administration of medication; pain relieving medications are advised. Short leg cast application or wearing of boot is suggested. Modification in shoes is a must. Use of orthodontic braces and devices is advised to support the arch. Physical therapy can be started which will help to strengthen the tendon and muscle and improve flexibility.
Other modes of treatment:
Certain yoga exercises or physical exercises under a trained physiotherapist will help to strengthen the muscles and ligaments and improve flexibility.
Complications:
As the condition progresses, the tendon deteriorates and eventually can lead to arthritis of the ankle.
When to contact a doctor:
Contact an orthopedic doctor if one experiences any pain, swelling, and discomfort in the ankle joint.
System involved: Musculoskeletal system
Organs involved: Bones, nerves, tendon, joints, and ankle
