A 48-year-old obese woman presents with insidious onset of right medial ankle pain, swelling, and progressive flatfoot deformity. She can stand on tiptoe on the left but is unable to perform a single heel rise on the right. MRI shows diffuse thickening and partial tear of the posterior tibial tendon. The stage of posterior tibial tendon dysfunction (PTTD) is:
- A Stage I — tendon intact with tenosynovitis, flexible flatfoot, able to heel rise
- B Stage III — tendon rupture, rigid flatfoot, hindfoot arthritis
- C Stage IV — rigid flatfoot with valgus tilt of talus in ankle joint
- D Stage II — tendon elongated/partial tear, flexible flatfoot, unable to heel rise ✓
Explanation
The Johnson and Strom classification of PTTD: Stage I — tenosynovitis without deformity, heel rise possible; Stage II — tendon elongation/partial tear with flexible hindfoot valgus, single heel rise ABSENT; Stage III — rigid flatfoot (fixed hindfoot valgus) with subtalar/talonavicular arthritis; Stage IV — rigid flatfoot plus valgus tilt of talus in the ankle mortise with deltoid ligament incompetence. This patient has flexible deformity (not rigid) with inability to heel rise, consistent with Stage II. Stage II is treated with medializing calcaneal osteotomy + flexor digitorum longus transfer.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.