الفهرس 
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Abstract
Posterior tibial tendon dysfunction (PTTD) is a well-recognized source of pain and walking dysfunction, and is one of the leading causes of acquired flatfoot deformity in adults.Several etiologies and precipitating factors where described for this condition. Although early reports suggested that the dysfunction arises from an inflammatory process in or around the tibialis posterior tendon, recent histological studies suggested that the changes associated with PTTD are more consistent with a degenerative process; the site of degeneration is just posterior and distal to medial malleolus, which is the zone of hypovascularity. It is common to be seen in patients with diabetes mellitus, obesity, hypertension and systemic inflammatory diseases The various presentations of this condition are divided into 4 stages according to the degree of pain, swelling and deformity. The characteristic deformity of PTTD consisting of forefoot abduction, loss of the longitudinal arch with increasing hindfoot valgus and a compensatory forefoot supinationThe diagnosis is usually made clinically, Physical examinations should include complete inspection of the patient from behind and front. Medial pain, swelling, loss of medial longitudinal arch or inability to perform a single or double heel rise, ”Too - many -toes Sign”, ”big toe extension test” can be elicited.