Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive medial ankle pain and swelling of the left foot. Symptoms are exacerbated by weight-bearing activities and prolonged standing. Patient reports a gradual loss of the medial longitudinal arch and difficulty with single-limb heel rise. No history of acute trauma.
Clinical Examination Findings
Left foot examination reveals visible flattening of the medial longitudinal arch (pes planus). Tenderness is localized along the course of the posterior tibial tendon distal to the medial malleolus. Single-limb heel rise test is weak or impossible on the left side. "Too many toes" sign is positive upon posterior observation. Neurovascular status is intact.
Treatment Protocol
Initiate conservative management including rest, activity modification, and non-steroidal anti-inflammatory drugs (NSAIDs). Prescribe custom orthotics or medial arch support. Recommend physical therapy focusing on strengthening the posterior tibial muscle and intrinsic foot muscles. Consider immobilization in a walking boot for 4-6 weeks if symptoms persist.