Posterior Tibial Tendon Dysfunction
(PTTD)
![PTTD]()
What Is
PTTD?
The posterior tibial
tendon serves as one of the major supporting structures of the foot, helping it
to function while walking. Posterior tibial tendon dysfunction (PTTD) is a
condition caused by changes in the tendon, impairing its ability to support the
arch. This results in flattening of the foot.
PTTD is often called “adult acquired flatfoot” because it is
the most common type of flatfoot developed during adulthood. Although this
condition typically occurs in only one foot, some people may develop it in both
feet. PTTD is usually progressive, which means it will keep getting worse,
especially if it isn’t treated early.
Causes
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact,
the symptoms usually occur after activities that involve the tendon, such as
running, walking, hiking, or climbing stairs.
Symptoms
The symptoms of PTTD may include pain, swelling, a flattening of the arch,
and an inward rolling of the ankle. As the condition progresses, the symptoms
will change.
![PTTD2]()
For example, when
PTTD initially develops, there is pain on the inside of the foot and ankle
(along the course of the tendon). In addition, the area may be red, warm, and
swollen.
Later, as the arch begins to flatten, there may still be
pain on the inside of the foot and ankle. But at this point, the foot and toes
begin to turn outward and the ankle rolls inward.
As PTTD becomes more advanced, the arch flattens even more
and the pain often shifts to the outside of the foot, below the ankle. The
tendon has deteriorated considerably and arthritis often develops in the foot.
In more severe cases, arthritis may also develop in the ankle.
Non-surgical
Treatment
Because of the progressive nature of PTTD, early treatment is advised. If
treated early enough, your symptoms may resolve without the need for surgery
and progression of your condition can be arrested.
In contrast, untreated PTTD could leave you with an
extremely flat foot, painful arthritis in the foot and ankle, and increasing
limitations on walking, running, or other activities.
In many cases of PTTD, treatment can begin with non-surgical
approaches that may include:
- Orthotic
devices or bracing. To give your arch the support it needs,
your foot and ankle surgeon may provide you with an ankle brace or a
custom orthotic device that fits into the shoe.
- Immobilization. Sometimes
a short-leg cast or boot is worn to immobilize the foot and allow the
tendon to heal, or you may need to completely avoid all weight-bearing for
a while.
- Physical
therapy. Ultrasound therapy and exercises may help
rehabilitate the tendon and muscle following immobilization.
- Medications. Nonsteroidal
anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain
and inflammation.
- Shoe
modifications. Your foot and ankle surgeon may advise changes
to make with your shoes and may provide special inserts designed to
improve arch support.
When Is
Surgery Needed?
In cases of PTTD that have progressed substantially or have failed to
improve with non-surgical treatment, surgery may be required. For some advanced
cases, surgery may be the only option. Your foot and ankle surgeon will
determine the best approach for you.
Information provided by The American College of Foot and Ankle Surgeons