Posterior tibial tendon dysfunction (PTTD), also referred to as acquired flatfoot, results from changes in the tendon at the back of the ankle. The condition impairs its ability to support the arch of the foot. As the condition progresses, it can lead to pain, swelling, and, eventually, a fallen arch or flatfoot. If treated early enough, symptoms can be resolved without the need for surgery.
What Is PTTD?
The posterior tibial tendon is the tendon at the back of the ankle that plays an important role in supporting the structures of the foot and helping the foot to function when walking. If the tendon becomes inflamed or torn, it can lead to PTTD. The condition is more common in women, but there are a number of factors that can contribute to PTTD, which can include:
- Sports-related injury and overuse
- Certain medical conditions, including obesity, hypertension, diabetes, and arthritis
PTTD typically develops in one foot, but it can also affect both feet. The condition is usually progressive, which means it tends to keep getting worse if left untreated. Symptoms of PTTD can include pain, redness, and swelling along the inside of the ankle and foot. As the arch in the foot flattens, it can cause pain in the outer and midfoot, an inability to stand on the toes, and weakness.
Early diagnosis and treatment can often help to stop the progression of PTTD. Your doctor can diagnose the condition by reviewing your medical history and carrying out a physical examination. They may also conduct imaging tests such as an X-ray, ultrasound, or MRI to check pictures of your ankle and leg structures. Your doctor will plan treatment according to the severity of your condition. Non-surgical treatment in the early stages can help prevent the need for surgery in the future. To treat the condition, 3 steps are usually taken initially.
Step 1 – Rest and Immobilization
In the early stages, pain and swelling can be treated with rest and medication. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, can help to reduce pain and inflammation. You will need to avoid weight-bearing for a while, and immobilization may also be recommended, which involves wearing a short-leg cast or boot to immobilize the foot and allow the tendon to heal.
Step 2 – Rehabilitation
Physical therapy usually follows immobilization and casting. It helps the ankle joint gain strength and improves the range of motion. Ultrasound therapy, exercises, and other modalities may be recommended to help rehabilitate the tendon and muscle.
Step 3 – Maintenance and Injury Prevention
In order to prevent problems in the future, your doctor may advise modifications to your shoes, and you may be issued an ankle stirrup or custom orthotic device to help improve arch support for your foot.
Custom orthotics are specially designed devices to support and protect your feet. They may include arch support shoe inserts, ankle bracing, or night splints to give your feet the reinforcement it needs and to support the arch of the foot. Orthotics are used for improving foot function and minimizing stress forces that can lead to foot pain or deformity. Orthotics are developed by taking an impression of the foot (a cast). The impressions in the cast duplicate any misalignments in the foot, which can then be corrected with compensation and stabilization techniques.
When Is Surgery Necessary?
Sometimes, surgery may be recommended if non-surgical treatments fail to relieve symptoms or for advanced cases of PTTD. There are several types of surgery, which may be carried out to:
- Remove inflamed tissue
- Improve the position of the heel bone
- Transfer another tendon for reconstruction
- Fuse the bones together to prevent movement and provide stability
More than one type of procedure may be necessary depending on the severity of your condition.
PTTD Treatment in Naples, FL
If you are experiencing pain associated with PTTD and would like to find out more about what treatments can help you, call the Joint Replacement Institute today. Our experienced podiatric surgeon, Dr. Cody Togher, can provide you with the best treatment to effectively treat your pain.