The posterior tibial tendon is one of the most important tendons of the leg. A tendon attaches muscles to bones, and the posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot. The main function of the tendon is to hold up the arch and support the foot when walking.
Posterior tibial tendon dysfunction is one of the most common problems of the foot and ankle. It occurs when the posterior tibial tendon becomes inflamed or torn. As a result, the tendon may not be able to provide stability and support for the arch of the foot, resulting in flatfoot.
An acute injury, such as from a fall, can tear the posterior tibial tendon or cause it to become inflamed. The tendon can also tear due to overuse. For example, people who do high-impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time leading to acquired flat foot syndrome (pes planus).
Posterior tibial tendon dysfunction is more common in women and in people older than 40 years of age. Many patients report having a flat foot virtually their whole life.Additional risk factors include obesity, diabetes, and hypertension.
- Pain along the inside of the foot and ankle.
- Pain worse with activity, especially high-intensity or high-impact exercises such as running
- Pain along the outside of the ankle as the arch collapses and you put more pressure in this position (lateral ankle impingement)
There are four stages of PTT insufficiency/dysfunction
- Stage 1: disease of the tendon in which no deformity has occurred
- Stage 2: disease of the tendon in which flexible deformities occur. The arch begins to collapse and there is increased hindfoot valgus.
- Stage 2a: no significant forefoot abduction
- Stage 2b: significant forefoot abduction has occurred
- Stage 3: deformity has progressed long enough where arthritis develops in the hindfoot joints, leading to a stiff deformity
- Stage 4: ankle is involved, either becoming arthritic or developing an increased valgus tilt
- Rest. Avoiding movements that exacerbate your pain.
- Heat and Ice can be applied to reduce pain and swelling. Apply for 20 minutes at a time, several times a day, to keep swelling down. Do not apply directly to the skin.
- Custom soft orthotics with medial arch support to take the load off the tendon. This is the most common and best place to start to support the foot.
- Rigid soled shoe wear with rocker bottom
- Lace-up ankle brace
- Hinged ankle-foot orthosis (AFO) with medial strap
- Nonsteroidal anti-inflammatory medicines. Drugs like ibuprofen and naproxen reduce pain and swelling. Like any over the counter medication, please read and follow the label. If you have a history of stomach ulcers, bleeding ulcers or heart conditions, these medications might not be right for you. Consult your physician if you have any questions.
- Physiotherapy. Under the direction of an experienced physiotherapists, many patients do well by strengthening of the calf muscles.
- Steroid (Depo-Medrol, Kenalog, Decadron)
- Blood (PRP – Platelet Rich Plasma)
Most of the treatment options for PTTD is conservative and non-surgical. However, failing conservative treatment options and in certain patients, surgery is an option and should be discussed with the physician.