Is the posterior tibial muscle weak in PTTD?

Is the posterior tibial muscle weak in those with posterior tibial tendon dysfunction? It usually feels like it when you do the inversion muscle strength testing compared to the eversion muscle strength. But it has been shown that almost all those with posterior tibial tendon dysfunction probably have a medially located subtalar joint axis. As a result of this it has been suggested that those with posterior tibial tendon dysfunction (PTTD) may not actually have a weak posterior tibial muscle and that the muscle testing is giving a false positive due to the mechanical disadvantage that the posterior tibial tendon has to the medially located subtalar joint axis. In other words, the lever arm from the axis to the tendon is shorter, giving the impression that the muscle is weak, when it may not be.

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