Posterior Tibial Tendon Dysfunction (PTTD)

One of the most important tendons in the lower extremity is the posterior tibial tendon. The tendon originates from the calf and travels down the inside of the ankle across the instep and inserts into the bones in the middle of the foot.

Function of Posterior TIbial Tendon is to support the arch of the foot and lock the foot as a rigid lever so that when the heel is lifted off the ground, the foot is stable enough to walk forward on.

Research has shown an increase incidence of posterior tendon rupture in obese middle-aged women and in patients who suffer from hypertension or diabetes.

In some people, the posterior tibial tendon finally “gives out” or tears. This is not a sudden event in most cases. Rather, it is a slow, gradual stretching followed by inflammation and degeneration of the tendon. Once the posterior tibial tendon stretches;

• Ligaments of the arch stretch and tear
• Bones of the arch then move out of position with body weight pressing down from above.
• The foot rotates inward at the ankle in a movement called pronation
• The arch appears collapsed, and the heel bone is tilted to the inside.
• The deformity can progress until the foot literally dislocates outward from under the ankle joint.

Signs and symptoms of the disorder include:

• Pain and swelling on the inside of the ankle.
• Loss of arch and development of a flatfoot.
• Gradual developing pain on the outer side of the ankle or foot.
• Weakness and an inability to stand on the toes
• Tenderness over the midfoot especially during physical activities

Examination

At The Footcare Centre the podiatrist examining the patient will take a complete medical history and ask about your symptoms. During the thorough assessment the podiatrist will check to see whether signs and symptoms for the condition are present.

Treatment

Due to the progressive nature of PTTD, early treatment is advised and in our opinion vital. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested.
In contrast, 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.

At The Footcare Centre we offer a wide range of non-surgical advice and treatment:

Orthoses: Most people can be helped with orthotics and in certain circumstances Richie Braces.

Orthoses work by:

• Supporting the arch at its optimum height, and preventing further collapse. This will reduce the abnormal pull on the tendon, and allow it to function without pain.
• Stabilising the foot to within “normal” ranges
• Providing shock absorption for the arch and tendon. Reduced shock absorption may lead to: stress fractures of the foot, heel and arch pain, shin splints, and knee, hip, and lower back pain.

An ankle foot orthoses known as the Richie Brace, has proven to show significant success in treating Stage II posterior tibial dysfunction and the adult acquired flatfoot.

Recent opinion and research argues that by starting with a Richie Brace to completely stabilise and rest the tendon then after 1 year to reduce down to an orthoses shows better success.

A Richie Brace is a sport-style brace connected to a bespoke orthotic device that fits well into most forms of lace-up footwear, including athletic shoes. The brace is light-weight and far more cosmetically appealing than the traditional ankle foot orthoses.

Please do not hesitate to contact The Footcare Centre to book a consultation with one of the podiatrists if you are suffering with the condition.