Posterior tibial tendon dysfunction (PTTD) is a common problem seen in the foot and ankle of middle aged adults. It is also more commonly seen in the female population. PTTD occurs when the posterior tibial tendon becomes inflamed or torn. As a result, the tendon may not be able to provide stability and support for the arch of the foot, resulting in a flatfoot deformity. Early intervention is key as the longer the condition exists and progresses the more involved treatment will become.

  • Condition

    Irritation and dysfunction of the of the tibialis posterior tendon.

  • Symptoms & Signs

    Pain just behind and under the medial ankle as well and into the arch when the foot is used in weight bearing activities. Swelling may also be noted on the inner aspect of the foot and ankle.

  • Treatment

    Custom foot orthotics, supportive ankle bracing and stability footwear are commonly used to reduce the irritation and overloading loading of the tibialis posterior muscle / tendon.

Symptoms & Cause

The tibialis posterior muscle is an important muscle that helps raise the heel at propulsion as well as supporting the medial (inner) arch of the foot by reducing excessive pronation. The effected side may begin to swell and become tender behind and under the ankle into the middle of the arch. The foot may change in appearance to a lower or flatter arch, and also “toe-out” more than the effected sign. When walking, pain may be noted in the arch at push-off or when trying to ascend stairs pushing off the effected side to raise up to the next step.

An acute injury, such as from a fall, can tear the posterior tibial tendon or cause it to become inflamed. Overuse from everyday activities or sports with repetitive hard push off moments , such as tennis, soccer or basketball can lead to posterior tibial tendon injury. These activities are by nature very repetitive and increase the risk to this region. Proper training and conditioning along with appropriate footwear are essential for prevention of most sport related foot and ankle injuries.

Pedorthic Treatment

A thorough biomechanical exam to determine range of motion, weakness and static alignment coupled with a gait assessment helps determine the course of conservative treatment.  The amount of foot collapse in cases of PTTD often requires the fabrication of custom orthotics to reduce excessive foot pronation and instability. When the deviation of foot and ankle becomes severe, the use of a brace supporting above the ankle in combination with supportive footwear and custom orthotics is required. In cases where the foot no longer can effectively push off at the propulsive phase of the walking cycle, a rocker sole modification can also be of assistance.

If you are experiencing foot pain or discomfort, you should consult your physician for a proper diagnosis and an appropriate treatment plan.

Your doctor may refer you to OKAPED to see a Canadian Certified Pedorthist for Pedorthic management of your foot pain. This may include orthopaedic footwear, shoe selection guidance, orthotics and/or foot related products such as ankle bracing. If you know your condition and want to learn about new products and treatments please give us a call.

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