East Coast Podiatry
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Last Updated: 12 Nov 2021

Posterior Tibial Tendon Dysfunction (PTTD)

Posterior Tibial Tendon Dysfunction (PTTD) is a progressive condition that affects the foot and ankle, and is a leading cause of Adult Acquired Flatfoot Deformity (AAFD).

The Posterior Tibial tendon is connected to the Tibialis Posterior muscle. This muscle is located deep in the posterior compartment of the lower leg and is responsible for raising the arch and supporting the foot and ankle during motion. The weakening of this tendon and the failure of ligaments around the foot and ankle is what leads to the collapse of the medial arch and an eventual flat foot deformity.

The majority of PTTD cases arise from repetitive strain to the Tibialis Posterior tendon. Although in some situations, an acute injury may also cause the tendon to tear, resulting in pain and inflammation.

Previously recognised as a common problem afflicting the elderly, PTTD has now become a more apparent issue amongst youths who are overweight, inactive, wear improper footwear such as slippers, or engage in high-impact sports.

Some risk factors of PTTD include:

  • Pre-existing flat foot
  • Hypermobility
  • Being 40 years or older
  • Obesity
  • Diabetes
  • Hypertension
  • High impact sports
PTTD Posterior Tibial Tendon Dysfunction Skeleton Feet

Symptoms of Posterior Tibial Tendon Dysfunction (PTTD):

  • Pain presents on the inside of the foot and ankle
  • Swelling may or may not be present
  • Increased pain and weakness in the foot during physical activities such as walking and running
  • 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 on the medial aspect of the foot as the foot collapses

How is Posterior Tibial Tendon Dysfunction (PTTD) Diagnosed?

Your podiatrist will conduct a physical examination of your foot shape and general range of motion. Diagnostic imaging such as an ultrasound can also be carried out to determine the severity and stage of the injury. Once the cause and diagnosis are determined, your podiatrist will be able to formulate an appropriate treatment plan.

How is Posterior Tibial Tendon Dysfunction (PTTD) Treated?

Ankle Foot Orthotic

Home remedies such as compression of the affected area using an elastic wrap or bandage can help reduce swelling. However, this should not be relied on as a solitary treatment method as compression alone is unlikely to heal the condition. This should only be used as a temporary form of relief before professional treatment is sought.

Professional treatment will include a range of non-invasive options. This includes offloading of the affected area and advanced treatment modalities such as focal shockwave therapy to stimulate healing and reduce pain.

Offloading of the injury comes in the form of custom foot orthotics, which are required to deter the flat foot deformity from worsening and reduce pressure placed upon the Tibialis Posterior tendon. In severe PTTD cases or upon visible change to the shape of your foot and ankle, an ankle-foot orthotic (AFO) may be required for adequate support to stabilise the foot and ankle at the same time.

PTTD must be treated promptly, cases that have delayed treatment or failed to show improvement even with non-invasive methods may require surgery. Speak to your podiatrist for more information.

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