Tendon Dysfunction and Foot Deformity Management

Tendon dysfunction within the foot, notably involving the posterior tibial tendon complex, underpins a spectrum of acquired deformities characterised by collapse of the medial longitudinal arch, hindfoot valgus and forefoot abduction. Early stages present with pain, swelling and biomechanical instability, progressing to rigid deformity if untreated. Management strategies span conservative measures—orthoses, physiotherapy and taping—to advanced imaging for precise morphological assessment and guided surgical reconstruction. Three-dimensional weight-bearing imaging now permits detailed evaluation of joint congruence and tendon alignment, informing decision making. Surgical options range from tendon transfer and soft-tissue augmentation in early stages to osteotomies and arthrodeses for fixed deformities, with rehabilitation protocols focused on dynamic arch support and muscle retraining to prevent recurrence.

Research from Nature Portfolio

Three-dimensional distance and coverage mapping using weight-bearing CT has revealed early alterations in the ankle and distal tibiofibular joint in patients with stage I flexible collapse of the medial arch. These objective metrics demonstrate narrowing of the syndesmotic incisura and reduced articular coverage of anterior tibiotalar facets, consistent with subtle talar plantarflexion in incipient deformity. Complementary cone-beam CT studies with advanced bone-segmentation techniques have quantified angular deformities in adult flexible flatfoot, confirming characteristic calcaneal valgus, talar plantarflexion and internal rotation. Automated and semi-automated reconstructions show high reproducibility and minimal inter-technique variation. Foundational cadaver investigations of single, double and triple hindfoot arthrodeses have mapped the three-dimensional kinematic consequences of each procedure, demonstrating progressive restriction of inversion-eversion and internal-external rotation, with triple fusions also limiting dorsiflexion-plantarflexion. These findings support patient-centred surgical planning by predicting postoperative motion loss.

Research from all publishers

A comprehensive review of tibialis posterior structure and function, informed by electromyographic studies, has highlighted its critical role in dynamic arch stability and identified altered activation profiles in both flat-arched posture and tendon dysfunction. Increased muscle activity during stance is noted in early dysfunction, with variable responses to antipronation taping and orthoses. A network meta-analysis comparing surgical treatments for adult acquired flatfoot deformity has synthesised direct and indirect evidence across reconstructive strategies. Results indicate that medial displacement calcaneal osteotomy provides optimal heel realignment in one metric, whereas lateral column lengthening or triple and double arthrodeses may be preferable when midfoot alignment or functional outcome scores are prioritised. This comparative approach underscores the importance of tailoring procedures to individual deformity characteristics.

Tendon Dysfunction and Foot Deformity Management publication trend

The graph below shows the total number of articles in tendon dysfunction and foot deformity management across all publications each year (not limited to Nature Index journals).

Technical terms

Progressive collapsing foot deformity (PCFD): A spectrum of adult flatfoot characterised by medial arch collapse and hindfoot valgus developing over time.

Weight-bearing cone-beam computed tomography (WBCT): A low-dose imaging technique capturing three-dimensional foot and ankle morphology under physiological load.

Arthrodesis: A surgical procedure fusing two or more bones to stabilise or correct deformity by eliminating joint motion.

Coverage mapping: A quantitative method to assess distribution and area of joint surface contact derived from three-dimensional imaging.

Principal Component Analysis (PCA): A statistical technique used in bone segmentation to establish anatomical reference frames for angular measurement.

References

1. Posterior Tibial Tendon Dysfunction: An Overview. The Open Orthopaedics Journal (2017).
2. Weight-bearing cone beam CT scans in the foot and ankle. EFORT Open Reviews (2018).
3. Distance mapping and volumetric assessment of the ankle and syndesmotic joints in progressive collapsing foot deformity. Scientific Reports (2023).
4. Angular and linear measurements of adult flexible flatfoot via weight-bearing CT scans and 3D bone reconstruction tools. Scientific Reports (2021).
5. Effects of five hindfoot arthrodeses on foot and ankle motion: Measurements in cadaver specimens. Scientific Reports (2016).
6. Tibialis posterior in health and disease: a review of structure and function with specific reference to electromyographic studies. Journal of Foot and Ankle Research (2009).
7. Surgical procedures for treatment of adult acquired flatfoot deformity: a network meta-analysis. Journal of Orthopaedic Surgery and Research (2019).