Posterior Tibial Tendon Dysfunction (PTTD)

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at Modern Orthopedics of New Jersey

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Posterior tibial tendon dysfunction (PTTD) is a painful, progressive condition that impacts the foot and ankle. The leading cause of adult-acquired flatfoot deformity, it is most common in middle-aged patients and can greatly restrict mobility and quality of life.

If you are suffering from ongoing, worsening pain on the inside of your ankle and foot, posterior tibial tendon dysfunction could be the cause. Below, we’ve provided an overview of the condition as well as its treatment options:

Overview of PTTD

Posterior tibial tendon dysfunction (PTTD), also known as posterior tibial tendonitis or posterior tibial tendon insufficiency, is a progressive condition that affects the posterior tibial tendon.

The posterior tibial tendon connects the calf muscle to the bones on the inside of the foot and supports the foot arch. Injury to or deterioration of this tendon can weaken support for the foot arch and cause it to flatten, resulting in severe pain in the foot and ankle. The degenerative process can also limit the range of motion and impact balance and mobility—including the ability to walk and run.

PTTD is most common in middle-aged patients but can also affect athletes in high-impact sports. Non-surgical treatment options such as customized foot orthotics for the condition are often helpful, but surgery may be indicated if these are not effective over time.

Common Symptoms of Posterior Tibial Tendon Dysfunction

The symptoms of PTTD may vary for individual patients depending on the severity of the condition. They may include:

  • Pain and/or swelling on the inside of the foot/ankle (may increase with activity)
  • Limited range of motion in the foot/ankle
  • Inward rolling of the ankle
  • Flattening of the foot arch
  • Difficulty standing, walking, running, or raising the heel to stand on tiptoe
  • Development of arthritis in the foot and/or ankle (more severe cases)

Visual Indicators of PTTD

Patients with PTTD often exhibit inward rolling of the ankle in combination with a flattened or collapsing of one’s foot arch. In addition, the toes may begin to point outward as degeneration of the posterior tibial tendon continues. A worsening limp may also be present.

Who Is at Risk of Developing PTTD?

PTTD commonly affects patients who:

  • Are over the age of 40 or who engage in high-impact athletic activities
  • Have obesity, high blood pressure, or diabetes
  • Have had a previous foot/ankle injury or surgery
  • Have a joint disorder
  • Use steroids
  • Overuse the ankle joint (e.g., long-distance runners, basketball players, etc.)

Diagnostic Tests for PTTD

The diagnostic process for PTTD typically begins with a physical examination. Your foot and ankle specialist will take a detailed medical history, test your foot’s range of motion, and observe you standing, walking, and performing specific movements. Diagnostic imaging tests, including X-ray, MRI, CT scan, or ultrasound, may also be ordered, depending on the specifics of your particular case.

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Treatment Strategies for Posterior Tibial Tendon Dysfunction

Less severe cases of PTTD can often be treated non-surgically. These types of treatment options may include:

  • Customized Orthotics
  • Shockwave Therapy
  • Immobilization
  • Rest
  • Ice
  • Medications
  • Physical therapy
  • Bracing

If PTTD does not improve with non-surgical treatment, surgical treatment options may be considered. Your foot and ankle specialist will tailor an individualized surgical approach to your specific needs. Surgical treatment for PTTD often involves reconstruction of the posterior tibial tendon.

Frequently Asked Questions About PTTD

What Activities Should Be Avoided When Suffering From PTTD?

Rest is important when treating PTTD, and high-impact activities that exacerbate the condition should be avoided.

What Happens if PTTD Is Left Untreated

PTTD is a progressive condition, which means that it will continue to worsen without treatment. Proactively treating PTTD early is strongly recommended.

How Fast Can I Recover From PTTD?

The length of time it will take for you to recover from PTTD will depend on the severity of the condition as well as your body’s response to treatment. After undergoing surgical treatment for PTTD, 6-8 weeks in a walking boot/ splint or cast non weight bearing may be required depending on the procedure performed. Following that, a thorough strengthening and conditioning program is followed.

What Does PTTD Feel Like?

PTTD is highly painful. In the early stages of the condition, pain is most commonly felt on the inside of the foot and ankle. In more severe cases, pain may also spread to the outer side of the foot and ankle with apparent deformity becoming visible.

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