Posterior tibial tendon dysfunction is a progressive condition that can be easily treated with an early diagnosis.

Flatfoot can lead to many foot and ankle problems down the road due to the strain it places on the tendons, ligaments, and bones.

However, there is a condition that leads to flatfoot. Posterior tibial tendon dysfunction, or PTTD, can cause flatfoot. The degeneration of the posterior tibial tendon that connects to the calf muscles and the bones of the foot weakens the arch and causes it to collapse.

PTTD is progressive, so an early diagnosis is important to receive successful conservative treatment. Learn more about PTTD below.

Posterior Tibial Tendon Dysfunction

What is PTTD?

PTTD is flatfoot that occurs in adulthood due to changes in the posterior tibial tendon.

This tendon attaches the calf muscles to the bone on the inside of the foot, maintaining the arch and supporting the foot during movement. Because of the posterior tibial tendon’s location and function, it is considered one of the most important tendons in the foot.

When the tendon goes through changes that cause it to become insufficient, it can cause the arch to collapse and flatten the foot. The change typically occurs in one foot, but some patients may develop PTTD in both feet.

This condition is progressive, so early diagnosis and treatment are necessary to prevent surgery. The severity of the condition is graded in four stages:

• Stage I: The patient experiences pain without deformity.
• Stage II: The arch is beginning to collapse and a feeling of weakness is present.
• Stage III: The collapse progresses, causing the foot to become fixed in the new position.
• Stage IV: The most severe stage results in a deformity of both the ankle and foot, which can lead to arthritis.

To prevent PTTD from progressing, visit your podiatrist to receive the right treatment for your feet.

Causes

PTTD is caused by the overuse of the posterior tibial tendon. For example, activities such as running or hiking can lead to PTTD.

Because PTTD is not commonly caused by acute trauma, the tendon weakens from gradual degeneration. Patients that already have flat feet or pronated feet place stress on the tendon and increase the likelihood of getting PTTD.

Also, patients who have chronic or recurring posterior tibial tendonitis are more at risk for developing the condition.

Symptoms of PTTD

With PTTD, patients may experience the following symptoms:

• Pain that shifts with the progression of the condition from the inside of the foot and ankle to the outside of the foot and below the ankle
• Inflammation of the foot and ankle (red, warm, and swollen)
• Flattening arch
• Turning the toes outward and rolling the ankle inward
• Inability to stand on one leg and raise the heel
• Limited mobility and/or flexibility
• In advanced conditions, arthritis of the foot and ankle may occur

Symptoms change as PTTD develops, so if you notice pain and swelling around the ankle and inside the foot even without a collapsing arch, call your podiatrist’s office. You may have PTTD and can experience a faster recovery without surgery with early treatment.

Posterior tibial tendon treatment

To determine the severity of the condition, Dr. Frankel will observe any flattening of the arch, the mobility of the foot and ankle, and ask about any pain you might be experiencing. 

Depending on your case, an MRI or ultrasound may be needed to observe the tendon. Additionally, a CT scan may be ordered to verify the severity of the condition by checking for arthritis.

Many cases of PTTD can be treated with non-surgical methods with early diagnoses. Nonsurgical treatments include:

• Rest: Taking a break from activities that aggravate the posterior tibial tendon will allow the tendon to heal.
• Orthotic devices or bracing: An ankle brace or custom orthotic device may be prescribed to provide arch support.
• Immobilization: A cast or boot may be necessary to immobilize the foot so the tendon can heal. Depending on the severity of the condition, the patient may need to avoid weight-bearing.
• Physical therapy: Exercises to rehabilitate the tendon and improve mobility and flexibility may be prescribed.
• Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation in and around the tendon.
• Shoe modifications: Patients may be advised to avoid wearing certain shoes, such as high heels or narrow-toed shoes.

If you don’t respond to the conservative treatments above, or if you have a posterior tibial tendon tear, then you may require surgery to fix your flatfoot. Your foot and ankle surgeon will choose the best surgery for your condition.

Prevention

Prevention is always the best way to treat health conditions.

For PTTD, you can practice prevention by using proper form when exercising. This is especially important for runners and other high-impact athletes who depend on the posterior tibial tendon for their sport. Visit a sports medicine doctor to learn the correct form and prevent weakening the tendon.

Wear shoes that provide support to the arch and do not shorten the tendons of the foot, such as high heels.

Stretch your calves and feet daily to keep them supple and strong.

Finally, be sure to check the condition of your feet daily. If you notice pain and a collapse of the arch, visit your podiatrist right away to determine the cause.

Get an early diagnosis at Frankel Foot & Ankle.

Prevent further deterioration of the posterior tibial tendon with an early diagnosis. If you are experiencing foot and ankle pain, visit Dr. Frankel to get the treatment you need for healthy, strong feet.

Visit Dr. Frankel today.

Dr. Frankel founded Frankel Foot & Ankle to provide patients in Pennsylvania, New York, and New Jersey tri-state area with the latest advances in diagnostic technology and treatment for sports medicine conditions, foot and ankle trauma response, and innovative surgical and regenerative approaches. Contact Frankel Foot & Ankle today. With locations in Warwick, NY, Middletown, NY and Milford, PA we are the go-to podiatrist for all your foot and ankle needs!