What is Posterior Tibial Tendon Dysfunction?

Posterior Tibial Tendon Dysfunction (PTTD) is a progressive condition that affects the foot and ankle, and is the leading cause of adult acquired flatfoot deformity (AAFD).

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Overview

The Posterior Tibial tendon is connected to the Tibialis Posterior muscle, located deep within the posterior compartment of the lower leg. Its main function is to elevate the arch and provide support to the foot and ankle during motion and movements. When this tendon weakens and the ligaments around the foot and ankle fail to provide adequate support, it results in the collapse of the medial arch, eventually leading to the development of a flat foot deformity.

The majority of Posterior Tibial Tendon Dysfunction (PTTD) cases result from repetitive strain on the Tibialis Posterior tendon. However, acute injuries may also cause tendon tears, leading to pain and inflammation.

Though it is a common problem afflicting the elderly, PTTD has become increasingly prevalent among youths, particularly those who are:

  • Overweight
  • Inactive
  • Wear improper footwear or
  • Engage in high-impact sports

Some risk factors of PTTD include:

  • Pre-existing flat foot
  • Hypermobility
  • Being age 40 years or older
  • Obesity
  • Diabetes
  • Hypertension
  • High-impact sports

Symptoms of Posterior Tibial Tendon Dysfunction (PTTD)

  • Pain on the inside of the foot and ankle
  • Swelling
  • Increased pain and weakness during physical activities such as walking and running
  • Gradual flattening of the affected foot
  • Ankle pain due to joint impingement from the collapsing foot deformity
  • Tingling and numbness due to nerve irritation

How is Posterior Tibial Tendon Dysfunction (PTTD) Diagnosed?

Your podiatrist will assess the shape of your foot and its range of motion and determine the severity of the condition. Diagnosis may also include imaging tests like ultrasound for an accurate assessment. Once the cause of the injury is determined, your podiatrist will create an appropriate care plan tailored to your specific needs.

How is Posterior Tibial Tendon Dysfunction (PTTD) Managed?

While home remedies such as foot compression can provide temporary relief for swelling, they are not long-term solutions and cannot address the underlying issue. Compression alone is unlikely to resolve the condition, making it crucial to seek podiatric management for a comprehensive solution.

A podiatrist can offer non-invasive options with advanced modalities such as focal shockwave therapy to stimulate healing and alleviate pain.

Custom foot orthotics play a crucial role in offloading the injury and preventing the progression of flat foot deformity by reducing pressure on the tibialis posterior tendon. In severe cases, an ankle-foot orthotic (AFO) may be recommended for enhanced support and stability.

Posterior Tibial Tendon Dysfunction (PTTD) must be managed promptly. If non-invasive methods fail to yield improvement, or if there's visible change in the foot or ankle shape, surgical intervention may be necessary. Do speak to a healthcare expert or a podiatrist for more information.

Early intervention is key to effectively managing flat foot deformity and preventing potential complications like chronic pain, arthritis, and functional limitations.

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Common Symptoms

Pain presents on the inside of the foot and ankle
Swelling
Increased pain and weakness in the foot during physical activities
A gradual flattening of the affected foot
Pain in the ankle due to joint impingement from the progressive collapsing foot deformity
Tingling and numbness due to nerve irritation

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An ankle specialist, such as a podiatrist, will be able to perform a thorough foot assessment using diagnostic tools, such as a musculoskeletal diagnostic ultrasound to determine the source of your ankle pain. If surgery is required, your podiatrist will refer you to a trusted foot and ankle doctor for surgical solutions.

A thorough assessment of your ankle

Immobilising the area with splints

Utilising technological therapies

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