Extract
The etiology of posterior tibial tendon insufficiency is
multifactorial; the disorder may be due to chronic attrition, rheumatoid
arthritis (in 13% to 64% of
cases1), chronic
overpronation, degenerative joint disease, or Charcot neuropathy. More than
half of the affected patients report no history of trauma. Rather, an
insidious and progressive flatfoot may develop with or without medial or
lateral pain in the
hindfoot2. Patients
with posterior tibial tendon insufficiency and a planovalgus foot demonstrate
abnormal kinematics during the gait cycle, including lateral shift of the
tibiotalar contact
area3
(Fig. 1), functional
malalignment3,
increased valgus stress at the
knee4,5,
and relative internal rotation of the tibia and talus (external rotation of
the foot)6. The
offset of the mechanical axis of the lower extremity increases with the
severity of the hindfoot
deformity3.
Consequently, these changes raise concern about potential problems with an
ipsilateral total knee arthroplasty. The purpose of this study was to evaluate
the relationship between failed total knee arthroplasties and ipsilateral
posterior tibial tendon insufficiency.