Posterior Tibial Tendon

Dysfunction (PTTD)

Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking or climbing stairs. Patient with flatfeet are the most common individuals that suffer from this condition.

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.

For example, when PTTD initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm and swollen.

Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and 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.

We are able to treat PTTD both surgically and conservatively. Custom orthotics or bracing is helpful to address pain and swelling by placing the foot under the leg. Most OTC braces are not helpful for this condition and only a select few have shown to improve pain. We offer both custom and OTC/ custom bracing in the office without the need of a Rx to a DME supplier.

PTTD as stated is mostly related with genetic or post traumatic collapsing flatfeet and overuse syndrome. Surgery is required to straighten out the foot with either osteotomies or arthrodesis of different bones depending on what joint or bone is the biggest factor. Evans osteotomy, Cotton Osteotomy, Kout ( medial calcaneal osteotomy ) are powerful surgical procedures that can straighten the foot at the same time with repairing the tendon. However, if PTTD is not treated successfully then joint arthritis develops. In these situations joint fusion are needed. Subtalar joints, TN joints, CC joint and or NC joints are requiring to be fused in a straight position.

Recovery from either surgery will require a minimum of 6 weeks without weight on the foot and can take up to 3 months to return to work.

If you are suffering from ankle pain or swelling, prior ankle injury, or weakness of the foot these condition maybe the underlying problem. Let one of our board certified foot and ankle surgeons assess your condition and develop a plan to resolve your pain.