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Supination Lag As an Indication of Posterior Tibial Tendon Dysfunction

Supination lag of the involved foot is a useful clinical sign that is indicative of posterior tibial tendon (PTl) dysfunction. With the patient seated on the edge of the examination table, both feet are plantarflexed and inverted in an attempt to bring the soles opposite one another. A simple side-to-side comparison of the amount of supination is made. A patient with unilateral PIT dysfunction will generally demonstrate a lag in the amount of inversion curvature of the foot or a loss of the amount of the sole of the foot on the affected side, as seen from above (Fig. 1). Supination of the foot maximizes the function of the posterior tibial muscle unit, because plantarflexing the foot minimizes the contribution of the anterior tibial muscle toward inversion. The posterior tibial muscle unit possesses only a 2-cm excursion 1 and therefore lacks significant reserve to make up for tendon attenuation. We found that this sign was easy to elicit and was a useful adjunct to the clinical evaluation of the PIT. This sign