Posterior Tibial Tendon Dysfunction (PTTD)

As a podiatrist, I see many patients who experience foot and ankle pain. One common condition I diagnose is posterior tibial tendon dysfunction (PTTD). PTTD affects the posterior tibial tendon, a crucial structure that supports the arch of your foot. When this tendon weakens or tears, it can lead to pain, flattening of the arch, and even deformity.

What is the Posterior Tibial Tendon?

The posterior tibial tendon originates in your calf muscle and runs down the inside of your leg and ankle. It connects to the bones of your midfoot, helping to maintain the arch and stabilize your foot during walking and running.

What Causes PTTD?

PTTD can develop due to various factors, including:

• Overuse: Repetitive activities that put stress on the tendon, such as running, jumping, or dancing, can lead to micro-tears and inflammation.
• Age-related changes: As we age, our tendons naturally lose strength and elasticity, making them more susceptible to injury.
• Foot biomechanics: Flat feet or abnormal alignment of the foot can put extra strain on the posterior tibial tendon.
• Obesity: Carrying excess weight increases stress on all your joints, including the ankle and foot.
• Certain medical conditions: Diabetes, arthritis, and inflammatory conditions can weaken tendons and make them more prone to PTTD.

Symptoms of PTTD

PTTD often progresses through stages, with each stage presenting different symptoms. Here's a general breakdown:

• Early Stage: Pain and tenderness along the inner ankle and arch, especially during activity.
• Mid Stage: Increased pain, swelling, and possible bruising. The arch may start to flatten.
• Advanced Stage: Significant pain, difficulty walking, and a pronounced flatfoot deformity. The ankle may also tilt inward.

Diagnosing PTTD

During a consultation, I will ask about your symptoms, medical history, and activity level. A physical examination will assess your foot and ankle for tenderness, swelling, and arch integrity. In some cases, imaging tests like X-rays or MRI scans may be necessary to confirm the diagnosis and rule out other conditions.

Treatment Options for PTTD

The good news is that PTTD is often treatable with conservative methods in the early stages. These may include:

• Rest: Reducing activities that aggravate the pain allows the tendon to heal.
• Immobilization: Wearing a walking boot or splint may be necessary to restrict movement and promote healing.
• Physical therapy: Exercises to strengthen the muscles that support the arch and improve flexibility can enhance stability and reduce stress on the tendon.
• Ice therapy: Applying ice packs to the affected area can help reduce pain and inflammation.
• Pain medication: Over-the-counter or prescription pain relievers can help manage discomfort.
• Orthotics: Custom-made shoe inserts can help support the arch and improve foot function.

When Surgery Might Be Needed

In severe cases where conservative treatments fail to provide relief, surgery may be recommended. Surgical procedures aim to repair the damaged tendon, realign the bones of the foot and ankle, or both.

Preventing PTTD

Here are some tips to help prevent PTTD:

• Maintain a healthy weight.
• Wear supportive shoes with good arch support.
• Warm up before and cool down after exercise.
• Gradually increase the intensity and duration of your activities.
• Strengthen the muscles in your feet and ankles.

If you experience persistent pain in your foot or ankle, especially along the inner arch, don't hesitate to schedule an appointment with a podiatrist. Early diagnosis and treatment of PTTD can prevent the condition from progressing and causing long-term complications.