Posterior Tibial Tendon Dysfunction (PTTD) is pain in the tendon that runs along the inside of your ankle and arch. You might feel it especially during and after walking, running and climbing stairs.
Symptoms include pain, swelling and the flattening of your arch. The condition usually gets worse over time.
Pain
If the posterior tibial tendon isn’t properly treated, it can gradually weaken and fail. This can cause your arch to flatten. Then your other foot structures must work even harder to support the arch, which causes more strain on them. This can create a vicious cycle that eventually wears down the tendons and ligaments and leads to a permanent collapsed flatfoot.
The most common symptoms of PTTD are pain on the inside of your foot and ankle where the posterior tibial tendon runs. You may have pain while walking, hiking or climbing stairs. You may also feel weakness during a single leg heel raise test or have trouble going up onto your tiptoes.
Your foot and ankle surgeon can diagnose PTTD by taking a history of your symptoms and performing a physical exam of your foot and ankle. They’ll feel around your arch and ankle for swelling, check for tenderness and do a diagnostic test to measure the strength of your posterior tibial tendon. This may include an X-ray, ultrasound or magnetic resonance imaging (MRI). A foot and ankle specialist can treat PTTD with orthotic devices or braces that fit into your shoes to give the arch more support. They can also prescribe exercises to strengthen the foot and ankle. If the condition progresses, surgery may be needed to correct the arch and take pressure off the failing tendons and ligaments.
Swelling
Symptoms include pain along the tendon path, usually right behind and below the inside ankle bump and arch. This can be most severe during or after activities that put a lot of stress on the foot and ankle, such as walking, running and climbing stairs. It can also be difficult to stand on one leg and rise up on “tiptoes.”
Chronic posterior tibial tendonitis can cause the tendon to break down and weaken (tendinosis). When this happens, the arch collapses gradually over time, causing flatfoot. In some cases, the condition can progress to a point where the ligaments and bones of the foot shift significantly, resulting in painful impingement and arthritis.
A healthcare provider can diagnose this problem by performing a physical exam and asking about your symptoms. They’ll feel around your ankle and foot for tenderness and move your foot and ankle in different positions. They may order imaging tests, such as X-rays or magnetic resonance imaging (MRI). These can create clearer pictures of soft tissues, like tendons and ligaments. Your doctor may also recommend non-steroidal anti-inflammatory drugs (NSAIDs), which can help reduce pain and swelling.
Deformity
Posterior tibial tendon dysfunction, also known as progressive collapsing flatfoot deformity (PTFD), can lead to a gradual flattening of the arch of the foot. Other, less obvious, changes can occur in the ankle and heel area. For example, the heel may angle outward from under the calf and ankle or the toes can appear to flare out laterally when looked at from behind (this is sometimes called the “too many toes” sign).
The pain in posterior tibial tendonitis is often felt along the path of the tendon which runs from the back of the ankle across the inside of the foot and then behind the small bump just before your arch. The pain can feel worse during or after walking, running and stair climbing activities. If the condition is not treated, the tendon can start to break down. This is referred to as tendinosis and can lead to PTFD. If the problem is severe, a person may find it difficult to stand on one leg and rise up on tiptoe. This is a sign that the arch collapses and places extra stress on other soft tissue structures, such as the spring ligament.
Activity Limitations
If your posterior tibial tendon becomes inflamed or tears, it can no longer support the arch of your foot and you may develop flatfoot. This condition is also known as progressive collapsing foot deformity or adult acquired flatfoot and can cause additional problems with the ligaments and bones of your feet.
Symptoms include pain along the inside of your ankle and foot where the tendon runs, swelling, and difficulty with the single leg heel raise (being unable to go up onto your tiptoes). Your doctor will be able to diagnose this problem by taking a thorough medical history, conducting a physical examination, and ordering diagnostic tests.
A number of randomised clinical trials have compared the effectiveness of local strengthening exercises with other forms of conservative management in individuals with PTTD. However, the quality of these studies is low and the exercise prescription parameters have not been well reported. The results suggest that strengthening exercises may be helpful in reducing pain and disability, although the benefit is not yet apparent in patients with severe PTTD.
Surgery
The posterior tibialis tendon is a strong cord of tissue that connects the calf muscle to the bones on the inside of your foot. If it becomes damaged or inflamed, you may develop a flatfoot. If non-surgical treatment methods don’t work, your doctor might recommend surgery. Surgery can involve lengthening your calf muscle, replacing the tendon, moving or fusing bones, and other procedures.
Your healthcare provider will take a detailed medical history and do a physical exam. They will look for swelling and tenderness around the back of your lower leg (calf) and the inside of your ankle. They might also order imaging tests, such as an X-ray or magnetic resonance imaging (MRI) scan, to see the damage.
The goal of treatment is to prevent or slow the progression of flatfoot deformity. To do this, your healthcare provider will try conservative treatments first, such as limiting activity and using braces or orthotic devices. They will also give you physical therapy. Medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), might help reduce pain and inflammation. If these don’t help, your healthcare provider might suggest surgery.