Posterior Tibial Tendon Dysfunction
Foot & Ankle Care of Colorado
Causes of Posterior Tibial Tendon Dysfunction
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.
Posterior Tibial Tendon Dysfunction 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.
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.
Posterior Tibial Tendon Dysfunction Diagnoses
Your healthcare provider will look for swelling along the posterior tibial tendon in your ankle and foot. They’ll move your foot from side to side and check your ankle’s range of motion. Swelling, tenderness and pain or weakness when moving your foot or ankle are early signs of PTTD.
Your provider will examine your foot from behind to look for any changes in its structure or shape. Your heel may point outward, and your inner arch may rest flat on the ground. The front of your foot may also move away from your body to counterbalance the changes to the heel and inner arch.
From behind your foot, your provider will also look for a “too many toes” sign. In a normal foot, only the fifth toe (pinky toe) and part or all of the fourth toe (ring toe) are visible on the outside of the foot. In those with PTTD, more toes may be visible.
A single-limb heel rise test can also determine the health of your posterior tibial tendon. For this test, you’ll stand next to a wall or chair to support your balance. Then you’ll raise your healthy foot off the ground and attempt to lift onto the toes of your affected foot. With a healthy tendon, you should be able to complete eight to 10 heel raises comfortably. In the early stages of PTTD, it may not be possible to complete one single heel rise.
Nonsurgical Treatments
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 nonsurgical 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 weightbearing 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 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 nonsurgical 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.
