Posterior tibial tendon dysfunction (PTTD) is a condition under which the posterior tendon of the foot becomes injured and is eventually unable to provide the required support to the foot. As a result, the arches of the foot eventually collapse. As a result, PTTD is closely associated with adult acquired flatfoot or flat feet. It is in fact the most common cause of adult acquired flatfoot. The initial symptoms of flat feet are pain and swelling on the inner ankle, eventually spreading to the outer ankle as well. Treatment of flat feet will usually start conservatively and include rest, icing and the use of shoe orthotics or ankle braces. If these approaches do not work, your doctor may decide to try cortiscosteroid injections or one of various types of surgery.
The posterior tibial tendon connects one of the small calf muscles to the bottom of your foot. It passes through the middle of your ankle and helps to maintain the arches of your foot as well as keep the foot optimally aligned with the rest of your body. This alignment is important in helping you to walk properly and support the weight of your body. Damage to the posterior tendon can therefore cause flattening of your foot arches and misalignment of your foot.
The most common cause of flat feet that appears in adulthood is overuse of the posterior tibial tendon. The activities that can give rise to this overuse include high impact forms of exercise like extensive running, walking, hiking or climbing stairs.
In other cases, flat feet can be the result of trauma of the posterior tibial tendon due to ankle fracture or a direct blow.
In many cases, PTTD may occur in one foot only. However, there are also cases in which it occurs in both feet.
The symptoms of flat feet are usually pain and swelling on the inside of the foot, near the ankle. In the advanced stages of the condition, this pain and swelling may spread to the outer foot. The area in which you experience pain and swelling may also appear red and warm to the touch.
Other symptoms that you may observe if you have flat feet are:
As the condition reaches its advanced stages, it may evolve into arthritis in the foot and ankle.
As can be seen from the above, PTTD or flat feet can develop into a serious problem if left untreated. You should seek urgent help if you suspect that you have this condition.
After confirming that you indeed have this condition, your doctor will likely try a conservative (non surgical) treatment option as a first option. If the PTTD proves resistant to these treatments, your doctor may consider and attempt a more aggressive approach like injections or surgery.
As a first option, and if your PTTD is mild, your doctor may first suggest resting the posterior tibial tendon. To do this, you can refrain from high impact activities for a period in order to give the posterior tibial tendon a chance to recover. Consider switching to low impact activities as alternative forms of exercise, like swimming or cycling. In addition, your doctor may suggest:
If your PTTD does not respond to conservative treatments, your doctor may decide to try surgical intervention. Surgery may be performed to:
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