Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

Orthopaedic Surgery

Answer 1
  1. More toes seen lateral to the heel from a posterior view. This finding is known as the “too many toes” sign and indicates tibialis posterior tendon (TPT) dysfunction. The patient presents subacutely with nontraumatic, degenerative inflammation of the TPT, which causes pain initially, edema below the medial malleolus, and loss of the medial longitudinal arch. This presentation is commonly seen in patients with acquired flatfoot, resulting in heal valgus and forefoot abduction. As a result, the posterior tibiocalcaneal angle, the angle formed by the heel and the longitudinal axis of the lower leg, is increased. Posterior tibial strength is decreased, so the patient cannot invert her foot effectively nor can she raise her body for the single heel raise test.1

     Lee MS, Vanore JV, Thomas JL, et al. Diagnosis and treatment of adult flatfoot. J Foot Ankle Surg 2005;44:78-113.

Click here to return to the questions


Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 1/04/08 • kkj