What is posterior tibial tendon dysfunction (PTTD)?
Posterior Tibial Tendon Dysfunction (PTTD) is a condition denoting inflammation, a tear or strain in the tendon that runs along the inside of the ankle and foot. This tendon is responsible for supporting the arch of the foot and aids in walking among other movements.
PTTD typically occurs in four different stages:
- Stage 1 – The tendon is stretched, but not damaged. Pain can be found in the instep of the foot, especially during activities like walking. The tendon supporting the arch of your foot may swell, but function and stability of the foot is not affected.
- Stage 2 – The tendon is torn to some extent. Pain and swelling become more severe. Flatfoot begins to present and standing on tiptoes on one leg is not possible.
- Stage 3 – The foot may start to appear deformed while flexibility in the heel dissipates.
- Stage 4 – In this most severe stage of PTTD, the ankle and foot will likely both experience deformity and arthritis may form in the ankle.
What causes PTTD?
Posterior tibial tendon dysfunction can lead to pain, swelling and a progressive flattening of the arch of the foot. If left untreated, PTTD can cause severe disability and arthritis in the affected area. Risk factors for PTTD include:
- Obesity
- Hypertension
- Diabetes
- Steroid Use
- Trauma or previous surgery in the ankle or foot
- Conditions such as Reiter’s Syndrome, which cause inflammation
- Excessive force place on the foot
- Prior tissue injuries in the foot or ankle
- Existing joint conditions
What are symptoms of PTTD?
Common symptoms of PTTD include:
- Swelling as it relates to the ankle and foot
- Arch collapse
- Inability to stand on the toes
- Trouble walking, especially on uneven ground
- Trouble going up or down stairs
- Unevenly worn shoes
- Pain when attempting to stand on the toes
- Pain and swelling on the inside of the foot and ankle that worsens with physical activity like standing or walking
- An inward rolling of the ankle
- Pain on the outside of the ankle
- Foot and toes that turn outward
How is PTTD diagnosed?
Diagnosing PTTD starts with an examination by your doctor. They will likely examine you from behind to check the positioning of the heel and any flattening of the arch which may be indicative of overcompensating for forefoot abduction. One of the most sensitive and reliable tests used in diagnosing PTTD includes a single limb heel raise in which the patient uses their arms for balance against a wall and lifts the opposite foot of the ground while simultaneously raising onto the toes of the affected foot. Patients with Stage 1 will likely be able to complete a few repetitions of this, but by stage 2, most are unable to perform a single one.
Following this physical examination and testing, it’s likely that your doctor may order imaging such as an x-ray, MRI, CT scan or ultrasound to further examine the affected area. Following diagnostic imaging, your doctor will read and interpret the results to best form a treatment plan.
What are treatment options for PTTD?
Treatment for PTTD will likely include most conservative measures, such as rest, ice, physical therapy, orthotic devices, and bracing. In the more severe cases of PTTD, surgery may be required to repair or reconstruct the damaged tendon.