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Posterior Tibial Tendon Dysfunction


Posterior tibial tendon dysfunction (PTTD) is an injury involving overstretching or rupturing of the posterior tibial tendon, leading to tendon inflammation, weakness, foot deformity and arthritis. The posterior tibial tendon extends from the deep layer of muscle at the back of your leg. It runs along the inside of your ankle and down the inside of your foot to underneath your arch. This tendon, along with some strong stabilising ligaments, is one of the major supporting structures of the foot. In PTTD, the tendon’s ability to perform that job is impaired, often resulting in a collapsed arch or ‘flat foot’. PTTD is the most common type of flat foot developed during adulthood, and is also known as adult-acquired flat foot.

Symptoms include pain and swelling on the inside of your ankle which grows worse with increasing activity, tenderness over the midfoot especially during activity, weakness or an inability to stand on your toes, a collapsed arch and development of a flat foot, and gradually developing pain on the outer side of your ankle.

How did I get this?

Often occurs in women over 50 years of age and may be due to an inherent abnormality of the tendon. But there are several other risk factors which include obesity, diabetes, hypertension, previous surgery or trauma, inflammatory diseases, and arthritis. The tendon may also become inflamed if excessive force is placed on the foot, such as when running on a banked track or road.

What can I do about it?

  • Rest.
  • Short term nonsteroidal anti-inflammatory drugs such as ibuprofen.

What help can I get for this?

  • Podiatrist may advise immobilization of the foot for six to eight weeks with a removable boot to prevent overuse.
  • Podiatrist may prescribe shoe inserts such as a heel wedge or arch support.
  • Podiatrist may recommend that you use a custom-made orthotic or support.
  • Foot and ankle surgeon for surgical management such as tendon repair or ankle joint fusion if conservative treatments don’t work.
  • A program of exercises and therapy to help rehabilitate the tendon and muscle following immobilization.

When will it get better?

The success of nonoperative treatment first requires the assessment of the flexibility of the flatfoot deformity. It is common for a patient to take 4-6 months to achieve much of their recovery and 12-18 months before they reach their point of maximal improvement after surgery.