Understanding Posterior Tibial Tendon Dysfunction

A common foot and ankle problem, posterior tibial tendon dysfunction is a condition that results when tendons are inflamed or torn. A podiatrist can determine whether you’re likely to respond well to standard treatments for PTTD or if you may have a situation that requires surgery to restore your arch and relieve your pain.

Posterior Tibial Tendon Dysfunction Causes

Attaching calf muscles to the inside bones of your foot, the posterior tibial tendon supports your arch and helps you maintain balance. More common in women and people over 40, PTTD can result after a serious injury, such as a hard fall directly on your foot or ankle, causes the tendon to become inflamed. Contributing causes or factors often include:

• Excessive wear of the tendon
• High-impact sports or exercise
• Diabetics and high blood pressure
• Tendon tears from repetitive use
• Obesity

Symptoms of Posterior Tibial Tendon Dysfunction

The inflamed or torn tendon often causes the arch of the foot to fall or completely collapse. Symptoms associated with PTTD may be mild at first or aggravated by certain foot and ankle movements. Once the arch falls, the heel bone may shift and place pressure on part of the ankle bone. Possible signs of damage to the tendon in this part of the foot include:

• Pain felt along the inside of foot/ankle
• Swelling or redness in the affected area
• Difficulty walking or standing for long periods

Diagnosing Posterior Tibial Tendon Dysfunction

While a clear flatfoot deformity is an obvious sign of advanced PTTD, it can be difficult to diagnose the condition in its early stages since foot pain can have many sources. A podiatrist often makes a diagnosis by:

• Considering your medical history
• Evaluating your range of motion
• Determining your foot/ankle flexibility
• Reviewing image tests

Posterior Tibial Tendon Dysfunction Treatments

Even with treatment, pain from PTTD may last for 4-6 months or more, depending on the extent of the damage to the tendon. Most patients respond well to a combination of treatments, including:

• Ibuprofen and other anti-inflammatory medications
• Immobilization with a short leg cast or walking boot
• Temporary use of a lace-up ankle brace
• Physical therapy
• Steroid injections

If you’re not experiencing relief with orthotics and braces, a podiatrist may recommend surgery to lengthen the Achilles tendon, remove inflamed tissue, or cut and shift bones. Since procedures to resolve PTTD may be complex in nature, the emphasis is likely to be on a combination of non-surgical remedies.