Adult acquired flatfoot and tibialis posterior tendonopathy

In 1969 Kettlekamp and Alexander drew attention to the association between failure of the tibialis posterior tendon and progressive flatfoot deformity in adults. Three of Kettlekamp and Alexander’s patients had lacerations to the posterior tibial tendon and trauma was a common feature of many of the early patient reports. Several series over the next 12 years reported numerous further cases and in 1989 Johnson and Strom classified the condition of "tibialis posterior tendon dysfunction" and proposed a system of treatment. Tibialis posterior tendon dysfunction came to be seen as " the commonest cause of the adult acquired flatfoot". Physical signs, as discussed later, were viewed as evidence of tibialis posterior insufficiency. Johnson and Strom discussed staging as though there were an established progression from tenosynovitis without foot deformity, through partial to complete rupture of the tendon with increasing but flexible deformity to fixed deformity without tendon function. Johnson and Strom’s treatment recommendations for most patients concentrated on replacing the function of the absent tendon.