Posterior Tibial Tendon Dysfunction

Causes

Overuse of the posterior tibial tendon is often the cause of PTTD. Symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.

Symptoms

The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change.

When PTTD initially develops, there is pain on the inside of the foot and ankle (along the tendon). In addition, the area may become swollen.

Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle and the foot and toes begin to turn outward while the ankle rolls inward.

As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably, and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.

Diagnosis

Non-surgical Treatment

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 and pain in the foot and ankle, and increasing limitations on walking, running, or other activities.

In many cases of PTTD, treatment can begin with non-surgical approaches that may include:

• Orthotic devices or bracing. 
• Immobilization. 
• Physical therapy.
• Medications. 
• Shoe modifications.

When is Surgery Needed?