Flat foot deformity icd 109/22/2023 ![]() Johnson and Strom stages: (Johnson KA, Strom DE: Tibialis posterior tendon dysfunction.Posterior Tibial Tendon Insufficiency Xray / Diagnositc Tests Flattening of the medial aspect of the longitudinal arch.Inability to walk on tiptoes or raise up on their toes on the affected side."Toe-many toes" sign (lateral two toes seen when pt standing, facing away from examiner, with feet straight ahead.Typically overweight middle-aged with hx of pes planus.Post tibialis isolated by plantarflexing. Inversion strength tested by having pt cross legs with affected foot on opposite knee. Weak plantarflexion and inverse with tendonitis, absent with rupture.Tenderness along course of posterior tibial tendon.In late stage patients may complain of lateral ankle pain due to fibular impingement. Pain & swelling in posterior medial ankle/foot.Arches gradually becomes flatter and is associated with swelling and discomfort over medial aspect of ankle.
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