Posterior Tibial Tendon Dysfunction (PTTD): Symptoms, Causes, Treatment

What are the symptoms of posterior tibial tendon dysfunction?

Posterior tibial tendon dysfunction (PTTD) is a condition that affects the posterior tibial tendon, which is crucial for maintaining the arch of the foot and providing stability. The symptoms of PTTD include:

Foot Pain: Pain along the inside of the ankle and foot, often exacerbated by activity.
Swelling: Swelling around the ankle or the inside of the foot.
Flattening of the Arch: Progressive flattening of the foot’s arch, which can lead to a flatfoot appearance.
Difficulty Walking: Trouble walking or bearing weight, especially on uneven surfaces.
Instability: A feeling of instability or weakness in the foot and ankle.
Tendon Tenderness: Tenderness or pain in the posterior tibial tendon, which runs along the inside of the ankle.
Heel Pain: Pain in the heel or the arch of the foot, especially when standing or walking.
Foot Deformity: Changes in the foot’s alignment or appearance, such as a more pronounced flatfoot or outward turning of the foot.

The symptoms can vary depending on the stage and severity of the condition, ranging from mild discomfort to significant pain and functional impairment. Early diagnosis and treatment are crucial to manage symptoms and prevent progression.

What are the causes of posterior tibial tendon dysfunction?

Posterior tibial tendon dysfunction (PTTD) can result from a variety of factors. Key causes include:

Overuse: Repeated stress or overuse of the tendon, especially from activities involving running, jumping, or prolonged standing.
Injury: Acute injuries or trauma to the ankle or foot that affect the posterior tibial tendon.
Aging: Degeneration of the tendon with age, which weakens its structure and function.
Biomechanical Abnormalities: Abnormal foot mechanics or alignment issues, such as flatfoot or overpronation, can contribute to increased stress on the tendon.
Inflammation: Conditions causing inflammation or swelling in the tendon, such as tendinitis or tendinosis.
Arthritis: Certain types of arthritis, such as rheumatoid arthritis, can impact tendon function and contribute to dysfunction.
Obesity: Excess body weight can put additional strain on the posterior tibial tendon, increasing the risk of dysfunction.
Genetic Factors: Inherited traits or conditions that affect the structure or function of tendons and ligaments.

Addressing these underlying causes and risk factors is important in managing and treating posterior tibial tendon dysfunction.

How is the diagnosis of posterior tibial tendon dysfunction made?

The diagnosis of posterior tibial tendon dysfunction (PTTD) involves a combination of clinical evaluation and imaging studies. The process typically includes:

Clinical Examination: A healthcare provider will review the patient’s medical history and ask about symptoms such as pain, swelling, and changes in foot shape or arch. A physical examination will include:

Visual Inspection: Observing the alignment of the feet and the presence of any visible deformities, such as flatfoot.
Palpation: Feeling along the posterior tibial tendon to check for tenderness, swelling, or abnormalities.
Range of Motion and Strength Tests: Assessing the movement of the ankle and foot, as well as the strength of the muscles that support the arch.
Gait Analysis: Observing how the patient walks to identify abnormalities in walking patterns, such as overpronation.

Imaging Studies: To confirm the diagnosis and assess the severity of the condition, imaging studies may be ordered, including:

X-rays: To evaluate bone alignment and rule out fractures or arthritis.
Ultrasound: To visualize the tendon and check for tears, inflammation, or thickening.
MRI (Magnetic Resonance Imaging): Provides detailed images of the tendon and surrounding soft tissues, helping to identify tears, degeneration, or other issues.

Special Tests: The healthcare provider may perform specific tests, such as the “too many toes” sign, where more than two toes are visible when viewed from behind, indicating flattening of the arch.

These diagnostic tools help determine the presence and severity of PTTD and guide appropriate treatment.

What is the treatment for posterior tibial tendon dysfunction?

The treatment for posterior tibial tendon dysfunction (PTTD) depends on the severity of the condition and may include both non-surgical and surgical options.

Non-Surgical Treatment

Non-surgical approaches are usually the first line of treatment, especially in the early stages of PTTD.

Rest and Activity Modification: Avoiding activities that exacerbate symptoms, particularly high-impact exercises, to allow the tendon to heal.

Orthotics and Braces: Custom orthotic devices or braces can help support the arch and reduce strain on the posterior tibial tendon. A short leg cast or walking boot may be used in more severe cases to immobilize the foot.

Physical Therapy: A physical therapist can provide exercises to strengthen the muscles around the tendon and improve flexibility. This can help support the arch and reduce stress on the tendon.

Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.

Weight Management: Reducing body weight can decrease the load on the foot and improve symptoms.

Surgical Treatment

Surgery may be considered if non-surgical treatments are ineffective and the condition has progressed to a more severe stage.

Tenosynovectomy: Removing inflamed tissue around the tendon.

Tendon Transfer: Replacing the damaged posterior tibial tendon with another tendon from the foot.

Osteotomy: Cutting and repositioning bones to improve alignment and support the arch.

Fusion: Fusing certain joints in the foot to correct alignment and provide stability.

Reconstruction: A combination of procedures to reconstruct the arch and repair or replace damaged tendons and ligaments.

The choice of treatment depends on the severity of the condition, the patient’s age, activity level, and overall health. Early diagnosis and treatment can often prevent the progression of PTTD and the need for more invasive interventions.