The objective of this presentation is to highlight the clinical and laboratory-based research related to posterior tibial tendon dysfunction (PTTD).

• Defining the flatfoot: clinical, foot pressure, radiologic

• Critical evaluation of flatfoot deformity: in vitro

• How often does the flatfoot occur?

• Normal arch development

• Why is the flatfoot a problem?

• Why does the flatfoot occur?

○ 1. Effects of weightbearing 1

○ 2. Lost of static support 2

○ 3. Loss of dynamic support 3

○ 4. Anatomic predisposition

○ 5. Joint subluxation

• Causes of flatfoot in adults

○ 1. Posterior tibial tendon dysfunction (PTTD)

○ 2. Arthritis: Midfoot, hindfoot, ankle

○ 3. Hypermobile flatfoot

○ 4. Neuropathic arthropathy

○ 5. Fracture malunion

○ 6. Inflammatory arthropathy

○ 7. Peroneal spastic flatfoot

○ 8. Neuromuscular disorder

○ 9. Other

• PTTD etiology

• PT muscle, tendon anatomy

• PT function

• PT muscle activity during gait

• Factors predisposing to PTTD

○ PT gliding resistance

• PT pathoanatomy

• Natural history of PTTD

• PTTD evaluation: symptoms, signs

• Investigative studies

• Gait analysis in PTTD patients

• Simulated walking: Normal, PTTD 4

• PTTD treatment

• PTTD treatment results

• Failures, complications

• Current recommendations