Johnson and Strom (1989) present a three-stage classification of tibialis posterior tendon (TPT) dysfunction, defining each stage by tendon integrity, hindfoot mobility, characteristic pain distribution, clinical examination findings, and radiographic changes — and pairing each stage with a specific treatment algorithm.
When a middle-aged patient presents with medial ankle pain and a positive single-heel-rise test, think PTTD and stage it immediately — a mobile hindfoot means you still have a reconstruction option (FDL transfer), but once the deformity is fixed, you're doing an arthrodesis.
Johnson and Strom (1989) present a three-stage classification of tibialis posterior tendon (TPT) dysfunction, defining each stage by tendon integrity, hindfoot mobility, characteristic pain distribution, clinical examination findings, and radiographic changes — and pairing each stage with a specific treatment algorithm.
When a middle-aged patient presents with medial ankle pain and a positive single-heel-rise test, think PTTD and stage it immediately — a mobile hindfoot means you still have a reconstruction option (FDL transfer), but once the deformity is fixed, you're doing an arthrodesis.