Posterior Tibial Tendon Dysfunction (PTTD) is a common type of flatfoot that occurs in adults, also often called the Adult Acquired Flatfoot. One of the main supporting structures of the foot, the posterior tibial tendon holds up the foot arch and assists in the walking movement. When the tendon gets torn or inflamed, the foot loses stability and support and the arch collapses, resulting in a flatfoot.
PTTD is an acute injury caused by a fall or traffic accident. It could also be an overuse injury usually caused by activities that involve intense usage of the tendon, such as running, hiking and soccer. The repetitive impact causes inflammation and tearing of the posterior tibial tendon over time.
Different symptoms develop as the severity of the condition increases. At the first stage, there would be pain, swelling and redness on the inside of the foot and ankle. When the arch begins to flatten, the forefoot and toes start to turn outward while the ankle leans inward with the same inner foot pain.
As the tendon further deteriorates, the arch gets even flatter. By then, the pain has shifted to the bottom outer side of the foot. There is a high risk of developing arthritis in the ankle in such severe cases.
As PTTD is a progressive condition, the earlier treatment starts, the better the chances to avoid surgery. In most cases, non-surgical treatment suffices to relieve the symptoms and keeps the condition from progressing further. Treatment may include the following methods.
- Rest and Ice
Reducing or stopping activities that aggravate the pain. Then ice 3-4 times a day every 20 minutes to bring down the swell.
A cast or boot is worn for 6 to 8 weeks to avoid weight bearing and allow the tendon to heal.
Orthotics and braces help to position and support the foot.
- Physical Therapy
Ultrasound therapy is used to reduce the inflammation while exercises help to reduce the stiffness of the muscles and regain stability.
Medication may be prescribed to reduce pain and inflammation. However, medication alone does not fully heal the injury.
If the symptoms do not improve after 6 months of conservative treatment, surgery would be required. Depending on the severity of damage, different types of surgery are used.
- Lengthening of Achilles tendon
- Cleaning the posterior tibial tendon of inflamed tissue
- Tendon transfer
- Cutting and shifting bones to support the arch
- Fusion of bones to remove the joint