Posterior tibial tendon dysfunction is the most common cause of acquired flatfoot in the adult. Additional risk factors include obesity, diabetes, hypertension, ligamentous laxity, steroid use, and previous involvement in high-impact sports. These pathologic processes can lead to reduction of effective excursion of the tendon or even rupture, resulting in progressive loss of the medial arch, midfoot abduction, and forefoot pronation. This disabling problem may be caused by trauma, degeneration, or inflammatory arthritides and is most commonly seen in late middle-aged, obese women. Posterior tibial tendon dysfunction is a condition, as its name suggests, that is characterized by the loss of function of the posterior tibial tendon. Its principal antagonist is the peroneus brevis, which normally everts the subtalar joint and abducts the forefoot. The tibialis posterior muscle, originating from the proximal tibia and fibula, passes distally with a broad insertion on the plantar aspect of the navicular, cuneiform, cuboid, and metatarsal bases and normally functions to invert the subtalar joint and to adduct the forefoot.
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