Stage 2 PTTD encompasses a wider spectrum of pathology.
Stage 2A is usually characterized by medial rearfoot
pain, edema, and tenderness along the course of the posterior
tibial tendon, and mild valgus of the heel, with or
without lowering of the medial longitudinal arch (24). There
may be some abduction of the forefoot on the rearfoot (too
many toes sign) (24). Although patients with stage 2A
PTTD may be able to perform a single heel raise, they are
more likely to have difficulty and pain completing this
maneuver. Subtalar joint motion is supple with increased
eversion. Radiographs typically reveal a flatfoot deformity
with increased talo-first metatarsal angle, peritalar subluxation,
and increased calcaneocuboid abduction angle. MRI
and ultrasound studies may reveal tenosynovitis, tendinosis,
or attenuation of the posterior tibial tendon