The tibialis posterior inserts primarily on the navicular tuberosity, from which it fans out to all tarsal bones. This broad insertion allows it to simultaneously invert the hindfoot, plantarflex the ankle, and lock the midfoot joints during push-off by supinating the foot. The navicular tuberosity insertion is the most common site of tibialis posterior tendon failure in adult-acquired flatfoot.
Dynamic medial arch support through the navicular-based pull; midfoot supination during push-off
Tibialis posterior tendinopathy at the navicular insertion produces medial hindfoot and navicular tuberosity pain reproduced by resisted foot inversion and passive eversion. MRI shows tendon signal change, thickening, or partial tear at the insertion. Ultrasound-guided injection at the navicular insertion can confirm the diagnosis and provide short-term relief. Progressive spring ligament incompetence accompanies tendon dysfunction in adult-acquired flatfoot.
Navicular tuberosity enthesopathy producing medial midfoot pain reproduced by resisted inversion, managed with orthotics and injection before considering surgical debridement and FDL transfer.
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