Posterior Tibial
Tendon Dysfunction

Common Foot Problems

Posterior Tibial Tendon Dysfunction (PTTD)

One of the main supporting structures of the foot, that helps function while walking, is the posterior tibial tendon. Changes in the tendon result in posterior tibial tendon dysfunction (PTTD). The tendon is less able to provide arch support, resulting in flattening of the foot.

PTTD is sometimes referred to as “adult acquired flatfoot” because patients most commonly develop this type of flatfoot during adulthood. This condition most commonly affects one foot, but some patients may develop it in both feet. Early treatment of PTTD is crucial because of its tendency to progress over time.

PTTD is commonly caused by wear and tear of the posterior tibial tendon. Symptoms are normally felt after activities involving the tendon, including running, walking, hiking or climbing stairs.

Patients may experience pain, swelling, a flattening of the arch and an inward rolling of the ankle. Symptoms often change as PTTD progresses.

In the initial stages, pain and weakness are felt in the tendon that runs along the inner side of the ankle. Patients may also notice redness, swelling and warmth in the injured area.

As PTTD progresses, the arch will begin to flatten and there may be continual pain on the inside of the foot and ankle. At this stage, the foot and toes begin to turn outward and the ankle rolls inward.

PTTD that progresses even further will result in severe flattening of the arch, and the pain shifting to the outside of the foot beneath the ankle. At this point, arthritis develops in the foot and the tendon deteriorates considerably. Arthritis may develop in the ankle as well in more severe cases of PTTD.

PTTD is a progressive condition that responds best to early treatment. In fact, timely treatment may result in significant improvement from non-surgical approaches and prevent further symptoms from arising.

If PTTD is left untreated, patients may develop a severely flat foot, painful arthritis in the foot and ankle, and difficulties walking, running or engaging in other activities.

Initial non-surgical treatments for PTTD can include:

  • Custom orthotic devices or an ankle brace. Dr. Radovic may recommend custom orthotics or an ankle brace to be worn in the shoe for maximum arch support.
  • Immobilization is often an important aspact of the healing process. Wearing a short-leg cast or boot, or possibly staying off of your feet helps the tendon heal.
  • Physical therapy exercises and ultrasound therapy can recover the muscle and tendon after a period of immobilization.
  • Ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) may relieve pain and inflammation.

Dr. Radovic may recommend specific types of shoes and certain inserts designed for better arch support.

Surgery may be the best option for patients who have been unresponsive to non-surgical treatments, or for patients with advanced PTTD. Some severe cases of PTTD may only be treated surgically. Dr. Radovic will determine the most suitable option for you.

To learn about Posterior Tibial Tendon Surgery

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