Posterior Tibial Tendon Dysfunction

Posterior tibial tendon dysfunction, or PTTD as it is more commonly called, is a condition that occurs when the posterior tibial tendon in the foot becomes overextended and inflamed. When this occurs, the foot’s arch is inadequately supported and the patient may develop flatfoot. The posterior tibial tendon is essential for supporting the foot and helping the foot function while walking, so injuries to this tendon can make it difficult to walk or stand comfortably.

Also called “adult-onset flatfoot,” PTTD is one of the most common types of flatfoot diagnosed in adults. Posterior tibial tendon dysfunction is progressive, so early treatment is highly recommended in order to minimize the pain and instability caused by it.

Signs and Symptoms of Posterior Tibial Tendon Dysfunction

Common signs and symptoms of early onset posterior tibial tendon dysfunction include:

  • Pain along the inside of the foot
  • Inflammation and redness
  • Swelling
  • Flattening of the arch
  • An inward rolling of the ankle

As the condition worsens, the signs and symptoms will change. For instance, there may still be pain experienced along the inside of the foot, but eventually the pain will shift to the outside of the foot as well. The toes will also start turning outward and the ankle will continue to roll inward. As the condition continues to worsen, most patients develop arthritis in the affected foot and ankle.

What Causes PTTD and How is It Diagnosed?

The most common cause of PTTD is simply overuse of the tendon. Therefore, runners, climbers, hikers, and other types of athletes are high-risk candidates for developing posterior tibial tendon dysfunction.

Diagnosis is made after closely examining the affected foot or feet and after reviewing the patient’s medical history. Imaging tests such as X-rays, MRIs, CT scans, and ultrasounds may also be ordered to help in the diagnosis of PTTD.

Non-Surgical Treatment Options for Posterior Tibial Tendon Dysfunction

PTTD can be effectively treated without surgery if treatment is administered by a professional foot and ankle surgeon as early on in the condition’s development as possible. Common conservative treatment techniques include:

  • Rest
  • Icing down the foot and ankle
  • Non-steroidal anti-inflammatory medications
  • Steroid injections
  • Leg cast or walking boot immobilization
  • Braces
  • Orthotics
  • Physical therapy

When is Surgery Needed?

If the condition has progressed to the point that conservative treatment techniques prove ineffective, then surgery may be recommended by the foot and ankle surgeon. There are several different types of procedures that can be used to help treat PTTD, including a tendon transfer, a gastrocnemius recession which lengthens the Achilles tendon, a tenosynovectomy, an osteotomy, and bone fusion. While most patients respond very well to surgical intervention, they should expect to still experience pain in the foot for up to 12 months after their surgery.

Regardless of the case, you surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Some of the most common insurances accepted. Please call our office if your insurance is not listed.