We discussed last week the development of flatfoot in
adulthood. There are some diagnostic
signs and tests that your podiatrist uses to determine if you have the
condition, as well as how far the condition has advanced.
Pain along the course of the posterior tibial tendon is the
most important sign when diagnosing PTTD.
The posterior tibialis tendon wraps around the inside of the ankle and
inserts on the arch. This allows the
muscle to support the arch. If there is
pain at the tendon’s insertion or pain when the doctor palpates the tendon as
it goes up the leg, you may be experiencing PTTD. If there is no pain, PTTD is unlikely.
Assuming there is pain along the tendon, there are other
tests that can be done to help confirm the diagnosis. The doctor will have the patient stand facing
the wall. The doctor will stand directly
behind the patient. Normally, the doctor
can only see the 4th and 5th toes, with the leg covering
the rest of the toes. In PTTD, when
positioned behind the patient, the doctor will be able to see almost all of
toes. This is known as the “too many
toes” sign.
Another test your doctor will use to grade the amount of
dysfunction is called the heel rise test.
The doctor will have you stand next to the wall or counter for
balance. You will then be asked to stand
on your toes, first each foot individually, then both feet together. In someone with PTTD, this will illicit large
amounts of pain in the arch and up the leg.
In more advanced situations, the patient will not be capable of lifting
their heels off the ground at all.
Patients often are surprised that they didn’t notice their inability to
lift up on their heels before their appointment.
