Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive medial ankle pain and swelling, exacerbated by weight-bearing activities. Reports a gradual loss of the medial longitudinal arch and increasing difficulty with single-heel rise. No history of acute trauma. Pain is localized along the course of the posterior tibial tendon, radiating toward the navicular insertion.
Clinical Examination Findings
Inspection reveals pes planus deformity with "too many toes" sign visible on affected side. Palpation demonstrates tenderness along the posterior tibial tendon distal to the medial malleolus. Strength testing shows weakness in ankle inversion compared to the contralateral side. Single-heel rise test is positive (inability to perform or failure to achieve heel varus). Gait analysis shows an antalgic pattern with midfoot collapse during stance phase.
Treatment Protocol
Initiate conservative management including RICE protocol, non-steroidal anti-inflammatory drugs (NSAIDs), and activity modification. Prescribe custom orthotics with medial arch support and a medial heel wedge. Referral for physical therapy focusing on eccentric strengthening of the posterior tibial tendon and intrinsic foot muscle conditioning. Consider immobilization with a walking boot for 4-6 weeks if symptoms persist.