A 45-year-old obese woman presents with progressive flat foot deformity with inability to single heel rise on the left side, pain over medial hindfoot, and too-many-toes sign when viewed from behind. MRI shows longitudinal tearing of the posterior tibial tendon. This stage of posterior tibial tendon dysfunction (PTTD) is classified as:
- A Stage I — tenosynovitis, normal alignment, heel rise preserved
- B Stage III — rigid fixed deformity with subtalar arthritis
- C Stage IV — rigid flatfoot with valgus tilt of the talus in the ankle mortise
- D Stage II — tendon elongation/partial tear, flexible flatfoot deformity, failed single heel rise ✓
Explanation
PTTD (adult acquired flatfoot) is staged by Johnson & Strom classification. Stage I: tenosynovitis with normal strength and heel rise, minimal deformity. Stage II: tendon elongation/partial tear causing flexible flatfoot — single heel rise is compromised or absent, too-many-toes sign positive, but deformity is reducible. Stage III: rigid flatfoot due to hindfoot coalition or subtalar arthritis, not correctable passively. Stage IV: Stage III plus deltoid ligament failure causing valgus tilting of the talus. This patient — partial tear, failed heel rise, flexible deformity — represents Stage II PTTD.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.