Posterior Tibial Tendon Dysfunction

What You Need To Know About PTTD

Understanding how PTTD develops helps you recognize symptoms and seek care early.

Understanding Posterior Tibial Tendon Dysfunction

The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot.

PTTD is often called adult acquired flatfoot because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, meaning it will keep getting worse, especially if it is not treated early.

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. Common symptoms include pain, swelling, a flattening of the arch, and an inward rolling of the ankle.

As the condition progresses, symptoms change. Early on, there is pain on the inside of the foot and ankle, and the area may be red, warm, and swollen. Later, the foot and toes begin to turn outward while the ankle rolls inward. In advanced cases, pain often shifts to the outside of the foot, and arthritis may develop.

If you think you may be experiencing symptoms of PTTD, please call us or request an appointment online so our doctors can evaluate your foot and recommend next steps.

Treatment Options for PTTD

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. Untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities.

In many cases, treatment can begin with nonsurgical approaches. Orthotic devices or bracing can give your arch the support it needs, and your doctor may provide an ankle brace or a custom orthotic device that fits into the shoe. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to avoid all weightbearing for a while.

Physical therapy also plays an important role. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.

Shoe modifications are another useful step. Your doctor may advise changes to your existing shoes, recommend new shoes, or prescribe special inserts designed to improve arch support.

In cases of PTTD that have progressed substantially or have failed to improve with nonsurgical treatment, surgery may be required. Your doctor will review your findings with you and determine the best approach for your situation.