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What is Posterior Tibialis Tendon Dysfunction? (PTTD)

PTTD is a condition that affects your foot and ankle. The Posterior Tibialis tendon connects the bones of your foot to the Posterior Tibialis muscle. This tendon’s main role in the foot is to provide stability and support for your arch as we go about our daily activities. When the tendon is subject to injury, swelling, and minor damage, the integrity of the tendon becomes poor, which results in gradual loss of the arch and eventually, a flat foot.

PTTD is the leading cause of Adult Acquired Flatfoot deformity. In certain cases, individuals with PTTD also have injuries to the ligaments of the foot, which additionally contributes to the flattening of the foot.

Individuals mainly suffer from PTTD due to repeated strain and damage to the tendon. However, this may not necessarily be the case all the time. Acute severe injuries can cause tears and damage to the tendon, which also precipitates pain and inflammation.

Generally, PTTD disproportionately affects females, and individuals above the age of 40. Individuals with certain conditions are also at a higher risk of PTTD, including – but not limited to:

  • Obesity
  • Diabetes
  • History of severe sprains or injuries to the foot and ankle
  • Previous surgery
  • Pre-existing flat foot
  • Hypermobility
  • Participate in intense and high impact sports

What will I experience?

Individuals that suffer from PTTD may experience the following symptoms:

  • Pain from inside or around the ankle region. This pain may increase with increased activity or walking. High intensity or impact activities such as running may be very difficult.
  • Swelling at the ankle region
  • Painful upon standing on tip toes. This may progress to a point where a single limb heel raise may not be possible
  • Pain on the outside of the ankle – as the foot collapses inwards, the outer part of the ankle may be under compressive forces, leading to pain at the outside of the ankle
  • Gradual flattening of the affected foot
  • Possible neurological symptoms such as tingling, numbness, pins and needles or burning sensations due to compression of the posterior tibial nerve.

How can we help you?

Your Podiatrist will first ascertain that you are experiencing PTTD. This will involve a detailed history of your injury as well as your symptoms. This will be followed by a thorough and detailed musculoskeletal and biomechanical assessment of your lower limbs to look for look for any deficits in muscle strength or tendon function.

X-rays can be very helpful for your Podiatrist to determine any bone or joint involvement, such as arthritis, in your injury. An MRI will allow your Podiatrist to understand the health of your tendons and surrounding ligaments or muscles.

Treatment of PTTD will depend on the stage and severity of your injury. Simple home treatments such as compression may help to reduce symptoms, but if you are experiencing PTTD, this should not be the only treatment. Your Podiatrist will be able to assess and discuss with you the best course of treatment moving forward. This may range from simple strapping and footwear recommendations, to activity modification and customised insoles.

The most common treatment is the use of custom orthotics to help with supporting the structure of the foot, and reducing the strain on the injured structures. Podiatrists specialise in comprehensive and advanced biomechanical assessment of your feet to prescribe your pair of insoles. Do get in contact if you are concerned about your foot condition.