Posterior Tibial Tendon Dysfunction (PTTD)

Posterior Tibial Tendon Dysfunction occurs when your posterior tibial tendon becomes irritated and inflamed. Your posterior tibial tendon runs along the inside of your ankle and foot to insert on the arch of your foot. Its job is to work in conjunction with other ligaments and tendons to help support the arch and keep your arch from collapsing and help the foot function while walking. When your posterior tibial tendon struggles with its job because of your lower limb biomechanics, it becomes inflamed and causes you pain. It also is unable to support your arch, resulting in flattening of your medial arch. 

PTTD is often called adult acquired flatfoot because it is the most common type of flatfoot that is developed in adulthood. This condition can develop in one or both feet. PTTD is usually progressive and will get worse if not treated early.

What causes PTTD?

PTTD typically develops when overuse of the posterior tibial tendon causes it to be inflamed and irritated. PTTD can be aggravated by activities like running, hiking, or walking.

Symptoms of PTTD

Symptoms of PTTD are:

  • Pain on the inside of your foot, that may travel up your ankle if the condition process progresses

  • Swelling along the posterior tibial tendon

  • Flattening of your arch

Conservative Treatment Options

  • Activity modification. Reduce the amount activity you are doing that you know aggravates your pain

  • Shoe gear modification – wearing good supportive shoes is critical when you have PTTD, because your shoes need to help support your posterior tibial tendon

  • Orthotics – in combination with good shoes, you need orthotics to help support your posterior tibial tendon

  • Anti-inflammatory medication – topical and oral anti-inflammatory medication can help ease pain caused by PTTD.

  • Physical Therapy – PT can be used to address the biomechanical causes of your PTTD and help you with your treatment plan

Surgical Treatment Options

If conservative treatment options fail, surgical intervention can be offered. Surgical intervention depends on the severity and level of deformity of your flatfoot.