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.

Symptoms may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. Early on, 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 flattens, the foot and toes turn outward while the ankle rolls inward. In more advanced cases, pain often shifts to the outside of the foot below the ankle, and arthritis can develop.

Overuse of the tendon is often the cause of PTTD, with symptoms usually occurring after running, walking, hiking, or climbing stairs. If you think you may be experiencing these symptoms, call us or request an appointment online so we can evaluate your foot and begin an appropriate treatment plan.

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, treatment can begin with nonsurgical approaches. Orthotic devices or bracing give your arch the support it needs, and your doctor may provide an ankle brace or a custom orthotic device that fits into the shoe. Immobilization with a short-leg cast or boot is sometimes used to allow the tendon to heal, and you may need to avoid all weightbearing for a period of time.

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, can help reduce the pain and inflammation. Your doctor may also recommend shoe modifications, new footwear, or 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.