Posterior Tibial Tendon Dysfunction

What You Need To Know About PTTD

Understanding posterior tibial tendon dysfunction and why early treatment matters.

Understanding Posterior Tibial Tendon Dysfunction

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 is not treated early.

The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. When PTTD initially develops, there is pain on the inside of the foot and ankle along the course of the tendon, and the area may be red, warm, and swollen. As the arch begins to flatten, 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 and sometimes in the ankle.

Overuse of the posterior tibial tendon is often the cause of PTTD. Symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs. If you think you may be experiencing symptoms of PTTD, do not hesitate to call us or request an appointment online.

Treatment Options for PTTD

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. Orthotic devices or bracing can give your arch the support it needs, whether through an ankle brace or a custom orthotic that fits into the shoe. Immobilization using a short-leg cast or boot allows the tendon to heal, and in some cases weightbearing must be avoided entirely for a period.

Physical therapy, including ultrasound therapy and targeted exercises, may help rehabilitate the tendon and muscle following immobilization. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation. Your doctor may also advise changes to your existing shoes, recommend new footwear, or prescribe special inserts designed to improve arch support.

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, and your doctor will determine the best approach for you. Our doctors are well-versed in this condition and can develop an effective treatment course to get you back in action as soon as possible.