The Different Stages of Posterior Tibial Tendon Insufficiency

Stage 1 is characterized by Tino-Cinnovitis with no deformity. Physical exam will have a positive single heel raise and radiographs will be normal. Stage 2 can be subdivided into stage 2a and stage 2b. On physical exam, patients will also not be able to do a single leg heel raise. Radiographs like in stage 2a will show arch collapse deformity. In stage 3 you may find forefoot abduction, which is seen in stage 2b disease. Finally, stage 4 is characterized by a flatfoot deformity,. rigid hindfoot valgus, and deltoid ligament compromise.