PTTD: Posterior Tibial Tendon Dysfunction
What is Posterior Tibial Tendon Dysfunction (PTTD)?
The posterior tibial tendon is one of the main supporting structures of the foot. It attaches the calf muscle to the bones on the inside of the foot, and its main function is to hold up the arch and support the foot whilst walking.
PTTD often called the adult acquired flatfoot, is a condition caused by degenerative changes in the tendon leading to pain and weakness. PTTD is progressive, which means early detection and treatment is key to ensure it does not progress to deformity of the foot.
What is the cause of PTTD?
The posterior tibial tendon can become inflamed or can tear following an acute injury. Overuse of the posterior tibial tendon is often the cause of PTTD. Quite often it is after activities that involve the tendon such as running, walking, climbing stairs or sports that result in repetitive use of the tendon can cause tears. Once the tendon becomes inflamed or torn, the arch will slowly collapse over time.
What are the symptoms of PTTD?
As PTTD progresses, the symptoms will also change.
Initially symptoms may include:
Pain along the inside of the foot and ankle, along the tendon. The area may also be red, warm and swollen.
Pain that is worse with activity.
As the foot collapses, the heel bone may shift to a new position outwards. The symptoms will now include:
Pain on the outside of the foot, below the ankle as there is greater pressure on the outside of the ankle bone.
What are the Treatment Options for PTTD?
There are a range of treatment options to discuss with your health professional which range from:
Rest and Ice - reduce or in some cases stop high intensity activities that cause pain. This allows the tendon to rest. To reduce swelling, place a cold pack in the affected area for 20 minutes, up to 3-4 times a day.
Orthotics - Orthotics are shoe inserts. They are the most common non-surgical treatment for a flat foot. Depending on the severity of your PTTD, you may require a custom orthotic which allows a greater degree of control to support the foot.
Braces - A lace up ankle brace may be prescribed to support the joints of the back of the foot and take tension off of the tendon.
Immobilization - A short leg cast or walking boot may be used for six to eight weeks to provide time for the tendon to rest. However, a cast will cause other muscles of the leg to weaken and therefore is only used when other conservative treatment options are not successful.
Surgery - Surgery should only be performed if non-surgical treatment options provide little to no relief or improvement after 6 months. For some advanced cases, this may be the only option. Your foot and ankle surgeon will determine the best approach for you.
Because of the progressive nature of PTTD, early treatment is advised. The Podiatrists at ProPodiatry Clinic in Brunswick and South Melbourne are well versed in PTTD and will be able to provide treatment options tailored to your individual needs. To book a consultation, call one of our clinics or book online.