Is Posterior Tibial Tendon Dysfunction?
Posterior tibial tendon dysfunction (PTTD) is a condition that
results in inflammation or tearing of the posterior tibial tendon. The
posterior tibial tendon connects one of the calf muscles to the bones located
on the inner foot. As a result, PTTD causes flatfoot because the tendon isn’t
able to support the arch of the foot. According to the American Academy of
Orthopaedic Surgeons, flatfoot is when the arch of the foot is fallen and
the foot points outwards.
PTTD is also known as adult acquired flatfoot. Doctors can usually
treat this condition without surgery, but sometimes surgery is necessary to
repair the tendon.
Are the Causes and Risk Factors of PTTD?
The posterior tibial tendon can sustain injury as a result of
impact, such as a fall or contact while playing sports. Overuse of the tendon
over time can also cause injury. Common activities that cause an overuse injury
- climbing stairs
- high-impact sports
PTTD is more likely to occur in:
- people over the age of 40
- people who are overweight or obese
- people with hypertension
Are the Symptoms of PTTD?
PTTD usually occurs only in one foot, though in some cases it can
occur in both feet. Symptoms of PTTD include:
- pain, typically around the inside of the foot
- swelling, warmth, and redness along the inside
of the foot and ankle
- pain that worsens during activity
- flattening of the foot
- inward rolling of the ankle
- turning out of the toes and foot
As PTTD progresses, the location of the pain may change. This is
because, as the problem progresses, your foot flattens and your heel bone
shifts. Pain may now be felt around the outside of your ankle and foot. The
changes to the posterior tibial tendon can cause arthritis in your foot and ankle.
Is PTTD Diagnosed?
Your doctor will begin by examining your foot. They may look for
swelling along the posterior tibial tendon. Your doctor will also test your
range of motion by moving your foot side to side and up and down. PTTD can
cause problems with side-to-side range of motion, as well as issues with moving
the toes toward the shinbone.
Your doctor will also look at the shape of your foot. They’ll
look for a collapsed arch and a heel that has shifted outward. Your doctor may
also check how many toes they can see from behind your heel when you’re
standing. Normally, only the fifth toe and half of the fourth toe are visible
from this angle. In PTTD, they can see more than the fourth and fifth toes. Sometimes
even all the toes are visible.
You may also need to stand on the leg that’s bothering you and to
try to stand up on your tiptoes. Usually, an individual with PTTD won’t be able
to do this.
Most doctors can diagnose problems with the posterior tibial
tendon by examining the foot, but your doctor may also order some imaging tests
to confirm the diagnosis and rule out other conditions. Your doctor may order X-rays
or CT scans if they think you have arthritis in the foot or ankle. MRI and
ultrasound scans can confirm PTTD.
Are the Treatments for PTTD?
Most cases of PTTD are treatable without surgery.
Reducing Swelling and Pain
Initial treatment helps reduce pain and swelling and allows your
tendon to heel. Applying ice to the sore area and taking nonsteroidal
anti-inflammatory medications (NSAIDs) can help reduce swelling and pain. Your
doctor will also advise you to rest and avoid activities that cause pain, such
as running and other high-impact activities.
Depending on the severity of your PTTD, your doctor may suggest
some form of support for your foot and ankle. An ankle brace can help take tension off the tendon and allow it to
heal more quickly. This is helpful for mild to moderate PTTD or PTTD that
occurs with arthritis.
Custom orthotics help
support the foot and restore the normal foot position. Orthotics are helpful for
mild to severe PTTD. If the injury to your posterior tibial tendon is severe,
your foot and ankle may require immobilization using a short walking boot. Individuals usually wear
this for six to eight weeks. It allows the tendon to get the rest that’s
sometimes necessary for healing. However, this can also cause muscle atrophy or
weakening of the muscles, so doctors only recommend it for severe cases.
Surgery may be necessary if the PTTD is severe and other
treatments haven’t been successful. There are different surgical options,
depending on your symptoms and the extent of your injury. If you’re having
trouble moving your ankle, a surgical procedure that helps lengthen the calf
muscle may be an option. Other options include surgeries that remove damaged
areas from the tendon or replace the posterior tibial tendon with another
tendon from the body. In more serious cases of PTTD, surgery that cuts and
moves the bones called an osteotomy or surgery that fuses joints together may
be necessary to correct a flatfoot.