Current RMA Instruments
| Reasonable Hypothesis SOP | 45 of 2021 |
| Balance of Probabilities SOP | 46 of 2021 |
SOP bulletin re new SOP condition
ICD coding
ICD-10-AM: M76.82
Brief description
This SOP covers inflammation or degeneration of the tendon of the posterior tibialis muscle. This is an important muscle for stabilisation of the (medial arch of the) foot and it is the primary inverter of the foot. The muscle lies deep in the calf and the tendon runs behind the inside of the ankle and inserts into the middle part of the inside of the foot (primarily at the navicular tubercle).
Confirming the diagnosis
The diagnosis is based on the clinical presentation. Imaging may also be undertaken (ultrasound, MRI). The condition can be diagnosed by a physiotherapist.
The relevant medical specialist is an orthopaedic surgeon or sports physician.
Additional diagnoses covered by these SOPs
Posterior tibialis / posterior tibial / tibialis posterior:
tendonitis
tenosynovitis
insertional tendinopathy
rupture
tendinosis
Conditions not covered by these SOPs
Flexor hallucis longis tendinopathy#
Medial ankle sprain*
Pes planus*
The term posterior tibial tendon dysfunction may be used to describe posterior tibialis tendinopathy and an associated flat foot deformity. The flat foot component of this diagnosis is covered by the pes planus SOP. Posterior tibialis tendinopathy is a factor in the (2021) pes planus SOP.
* another SOP applies
# non-SOP condition
Clinical onset
The usual presentation is with pain at the inner lower leg and ankle, increasing over weeks, without a traumatic event. There may be tenderness along the course of the tendon or over the insertion at the inner mid foot. The clinical onset is the earliest time prior to the confirmation of the diagnosis, that a set of symptoms and signs consistent with the diagnosis could be identified.
Clinical worsening
The clinical course in variable as is the response to therapy. The condition may resolve or may become chronic. Treatment may include physiotherapy, immobilisation, and in some cases surgery (particularly for tendon ruptures).