Heel raise to assess posterior tibialis and spring ligament

(A) The posterior view shows a patient with collapse of the longitudinal arch at the midfoot (white horizontal double arrow) rather than the hindfoot, as there is no valgus malalignment in the left foot and only slight valgus on the right (white vertical double arrows).
(B) The anterior view shows bilateral foot pronation with complete loss of the longitudinal arch (black double arrow).
(C) A heel raise test is performed to assess posterior tibialis (PT) function. As the patient performs a heel raise, the longitudinal arch reforms as the PT muscle contracts, indicating an intact PT tendon. Intact PT function with collapse of the longitudinal arch at rest indicates that the calcaneo-navicular (ie, spring) ligament is not functioning properly.