Posterior Tibial Tendon Dysfunction (PTTD)

What Is Posterior Tibial Tendon Dysfunction?

Posterior Tibial Tendon Dysfunction (PTTD) is a condition that affects the posterior tibial tendon, which runs along the inside of your ankle and foot. This tendon plays a key role in supporting the medial longitudinal arch of your foot as it helps control your foot's movement while you’re walking or running.

When the tendon becomes damaged or weakened, it can lead to a series of symptoms that impact your ability to walk or stand comfortably. Unfortunately, PTTD is often progressive, meaning the condition can worsen over time if it isn’t properly managed. This leads to an acquired flatfoot deformity and potentially severe flatfoot.

Although PPTD is commonly seen in adults, especially those over the age of 40, it can affect individuals of any age. Like any condition, the severity can vary greatly from person to person. No matter your age or how extreme your symptoms of posterior tibial tendonitis are, we’re here to help. At PrimeCare, we’re here to provide the support and hands-on care you need to regain your mobility and reduce discomfort.

Stages of Posterior Tibial Tendon Insufficiency

Posterior Tibial Tendon Insufficiency (PTTI) is a progressive condition that impacts the tendon supporting the arch of the foot. As the tendon weakens, the stages of PTTI reveal increasing levels of dysfunction. We’ve provided a breakdown of the condition’s typical progression:

• Stage 1: It starts with mild pain and swelling that often occurs along the inside of the ankle. There aren’t visible changes in foot structure or function.
• Stage 2: Next, the tendon becomes weaker, leading to a gradual collapse of the foot arch. Patients may notice flatfoot deformity and experience difficulty walking or standing for long periods. The tibialis posterior muscle loses its function in supporting the arch, which leads to medial arch collapse.
• Stage 3: Then come significant foot deformities, including severe flatfoot, misalignment, and reduced mobility. The tendon may rupture, causing chronic pain and further dysfunction. This stage might also involve damage to the spring ligament and other supporting structures, causing foot pain and swelling to intensify.
• Stage 4: The last stage is the advanced degeneration of the tendon and joint that often affects the ankle and foot joints. This stage can severely limit mobility and may require surgical intervention.

What Are the Signs and Symptoms of PTTD?

The symptoms of PTTD can range from mild discomfort to more severe impairments in foot function. Here are the key signs to look out for:

• Pain and Swelling: The most common symptom of PTTD is pain along the inside of the ankle and foot. This pain is often accompanied by swelling, especially after activity.
• Flatfoot Deformity: As the posterior tibial tendon weakens, it can no longer support the arch of the foot effectively. This can result in a flattening of the foot's arch, leading to a collapsed or flatfoot appearance. This is commonly referred to as adult-acquired flatfoot.
• Difficulty Walking: If left untreated, the dysfunction of the posterior tibial tendon can lead to trouble walking. You might notice that you struggle to bear weight on your foot or feel an unusual imbalance while standing or walking.
• Imbalance: The loss of proper arch support and altered foot mechanics can affect your balance and make you more prone to falls.
• Fatigue in the Foot and Leg: Individuals with PTTD may also experience fatigue in the foot or leg due to overcompensation from other muscles. This can make it difficult to engage in long periods of walking or standing without discomfort.

What Causes Posterior Tibial Tendon Dysfunction?

PTTD occurs when the posterior tibial tendon becomes overstressed, damaged, or inflamed. The condition is most often caused by one or more of the following:

• Overuse or Repetitive Strain: Activities that involve prolonged standing or excessive walking can put stress on the posterior tibial tendon. Athletes, especially runners, are often at risk, as repetitive motion can cause wear and tear on the tendon.
• Aging and Wear: As we age, the posterior tibial tendon can lose its elasticity and become less effective at supporting the foot's arch. This degenerative process is a common cause of PTTD in older individuals.
• Obesity: Excess weight can place added strain on the feet and ankles, contributing to the development of PTTD. The increased load on the posterior tibial tendon could lead to its dysfunction over time.
• Diabetes: Diabetic neuropathy and poor circulation can affect the tendons and ligaments in the feet which increases the risk of tendon damage and dysfunction.
• Trauma or Injury: Previous injuries to the ankle, such as sprains or fractures, can compromise the integrity of the posterior tibial tendon and lead to PTTD.

How Is PTTD Diagnosed?

Diagnosing PTTD isn’t always straightforward and it involves a comprehensive evaluation, including:

• Physical Exam: A doctor will conduct a physical exam to assess the alignment of the foot and ankle, as well as any signs of swelling or deformity. They'll also check for tenderness along the inside of the ankle and observe your walking pattern.
• Medical History: Another important factor in diagnosing PTTD is understanding your health history, including any past injuries or conditions like diabetes.
• Imaging Tests: X-rays, MRIs, or ultrasound images can help spot signs of tendon damage, joint misalignment, or bone abnormalities. An MRI, in particular, can show soft tissue damage to the posterior tibial tendon.
• Functional Assessment: In some cases, a doctor may assess your gait and the overall function of your foot to better understand how the tendon dysfunction is affecting your movement.

What Is the Treatment for Posterior Tibial Tendon Dysfunction?

There’s no one-size-fits-all approach and treatment of PTTD varies depending on how severe the condition is. Early intervention can often prevent the progression of the disease, while more severe cases may require surgical intervention. Here are the most common treatment options:

Rest and Activity Modification

Resting the affected foot and reducing activities that place stress on the posterior tibial tendon (such as running or standing for long periods) can help reduce inflammation and allow for the condition to heal.

Physical Therapy

A customized physical therapy program can strengthen the muscles supporting the foot and ankle, improve flexibility, and address any gait abnormalities caused by PTTD. Therapy can also help improve overall function and reduce pain.

Orthotic Treatment

Custom-designed orthotics, including arch supports or ankle-foot orthoses (AFOs), can help provide the necessary support to the foot's arch and reduce strain on the posterior tibial tendon. Orthotics can improve alignment, restore function, and alleviate pain that’s associated with the condition.

Braces

In more advanced stages of PTTD, braces that support the ankle and provide stability may be recommended. These devices help prevent further deformity and help with walking.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. In more severe cases, corticosteroid injections may be used to reduce inflammation in the tendon.

Surgery

If conservative treatments like the above options don't offer sufficient relief, surgery may be needed. Surgical options include:

• Tendon Repair or Reconstruction: Surgical repair of the posterior tibial tendon can restore function and prevent the arch from collapsing further.
• Tendon Transfer: In some cases, a healthy tendon from another part of the body may be transferred to compensate for the damaged posterior tibial tendon.
• Osteotomy: Surgery to realign the bones of the foot or ankle may be necessary in severe cases.

At PrimeCare Orthotics & Prosthetics, we know how difficult and painful it can be to live with Posterior Tibial Tendon Dysfunction. That’s why we offer custom braces and supportive devices specifically designed to relieve pain, stabilize your foot, and help you walk with more ease. Our goal is to be there for you throughout every step of your recovery, helping you regain comfort and confidence in your movement.

If you’re experiencing symptoms of Posterior Tibial Tendon Dysfunction, early intervention is crucial. We recommend consulting with a healthcare provider, like a podiatrist, who can assess your condition and guide you toward the best treatment options for your needs. Let us help you take the next step toward a smoother and more comfortable recovery.

Can You Prevent Posterior Tibial Tendon Dysfunction?

Unfortunately, this condition isn’t entirely preventable, but you can reduce the risk of developing PTTD by taking steps to care for your feet and ankles. These include:

• Maintaining a healthy weight
• Wearing the proper footwear
• Avoiding overuse
• Addressing any foot or ankle injuries as soon as possible

If you have a condition like diabetes or have experienced an injury, regular check-ups with a healthcare provider can help catch early signs of PTTD before it becomes more severe.