ARRS 2022 Abstracts

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E1451. The Arch Nemesis: Spectrum of Dynamic and Static Soft Tissue Stabilizers Dysfunction and Collapse of the Medial Plantar Longitudinal Arch
Authors
  1. Juliana Sitta; University of Mississippi Medical Center
  2. Andrew Palmer; University of Mississippi Medical Center
  3. Kathryn Nutter; University of Mississippi Medical Center
Background
The posterior tibial tendon plays a crucial role in the stabilization of the longitudinal plantar arch. A thorough understanding of the foot anatomy, function, and pathology spectrum is imperative to assess for complications derived from posterior tibial tendon and secondary stabilizers dysfunction and guide appropriate management.

Educational Goals / Teaching Points
The goals of this exhibit are to review the posterior tibial anatomy, biomechanics, vascular supply, innervation, and relationship with bones and the arch stabilizing ligaments, spring ligament, sinus tarsi and plantar fascia; discuss the causes of posterior tibial tendon dysfunction and potential consequences on neighboring ligaments and the plantar arch; and illustrate the imaging findings of posterior tibial tendon pathology and the spectrum of complications in the hindfoot and plantar arch.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This educational exhibit will deepen the understanding of imaging of the posterior tibial tendon pathology using didactic illustrations and case samples. The biomechanics and relationship with secondary stabilizers will be explored, including the full spectrum of complications from posterior tibial dysfunction and its associations such as tendinopathy, tenosynovitis, acquired pes planus, hindfoot deformities, lateral hindfoot impingement, sinus tarsi syndrome, spring ligament disruption, and peroneal tendon subluxation.

Conclusion
The posterior tibial tendon is the primary stabilizer of the plantar arch. Its progressive dysfunction and ultimately rupture, leads to a cascade of imbalance and deformity in the foot, which overloads secondary stabilizers. A thorough understanding of the posterior tibial tendon biomechanics, pathology, and complication spectrum is crucial to fully identify potential sources of and solutions for ankle and foot pain and dysfunction in these patients.