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Tibialis Posterior

- Anatomy:
    - origin: lateral part of posterior surface of tibia, medial 2/3 of fibula, interosseous membrane, intermuscular septa and deep fascia;
    - mid course:
             - it runs in the deep post compartment and passes posterior to the medial malleolus;
                     - here it changes direction from a verticle to horizontal direction;
             - it is held in position behind the medial malleolus by the flexor retinaculum;
    - insertion:
             - major tendon insertion passes to tuberosity of navicular;
             - posterior tendon slips pass to sustenaculum tali of calcaneus, plantar surface of all 3 cuneforms, cuboid and to base of 2nd,
                      3rd, and 4th metatarsals;
    - nerve supply: tibial: L5, S1;
    - action:
             - inverts and plantar flexion of the foot at the ankle;
             - medial ankle stabilizer;
             - synergists: FHL, FDL.

- Rupture of the Tibialis Posterior:

- Paralysis: of Tibialis Posterior:
    - paralysis of tibialis posterior alone causes a planovalgus deformity;
    - normally this muscle inverts foot during plantar flexion, and when it is paralyzed, valgus deformity develops;
    - must patients may be treated by an polypropylene AFO;

Spasticity of Tibialis Posterior:
    - dynamic varus deformities of foot are commonly due to spasticity of posterior tibial muscle (active in the stance phase) &
            anterior tibial muscle (active in swing phase);
    - consider transferring lateral half of split posterior tibial tendon to the peroneus brevis tendon;
    - advantage of this operation is that strength of plantar flexion is preserved

 Split posterior tibial-tendon transfers in children with cerebral spastic paralysis and equinovarus deformity.

 Posterior tibial-tendon transfer in patients with cerebral palsy.

 Vascularity of the posterior tibial tendon

 Combined split anterior tibial-tendon  transfer and intramuscular lengthening of the posterior tibial tendon.   Results in patients who have a varus deformity of the foot due to spastic cerebral palsy.

 Transposition of the posterior tibial tendon.

 Split posterior tibial-tendon transfer in spastic cerebral palsy.

 Operative treatment of the plantar-flexed inverted foot in adult hemiplegia.

 The cincinnati incision for the split posterior tibial tendon transfer: a technical note.

 Dislocation of the posterior tibial tendon.

 Biomechanical study on tibialis posterior tendon transfers.

 Posterior tibial tendon transfer through the interosseous membrane to correct equinovarus deformity in cerebral palsy. An inital experience

 The tibialis posterior muscle compartment. An unrecognized cause of exertional compartment syndrome

 Variations on the insertion of the posterior tibialis tendon: a cadaveric study.