Posterior Tibial Tendon Dysfunction
Posterior tibial tendonitis or posterior tibial tendon dysfunction (PTTD) is an inflammation and/or overstretching of the posterior tibial tendon in the foot. One of the most important functions of the posterior tibial tendon is to support the arch. In PTTD the ability of the posterior tibial tendon to function properly is impaired resulting in flattening of the foot. This is condition is sometimes referred to as adult-acquired flatfoot because its the most common type of flatfoot that develops in adulthood.
Pain may be experienced anywhere along the tendon, from the bottom of the arch to the inside of the ankle. Over time, the tendon become dysfunctional in its ability to support the arch. Flat feet can exacerbate this condition, adding more stress to an already diseased tendon, creating a vicious cycle. In later stages of the condition the arch flattens out even more with pain felt on the outside of the foot below the ankle. Both arthritis of the foot and ankle often develop as a result.
Clinical examination often shows pain wtih direct pressure on the tendon, weakness of the muscle, a progressing flatfoot deformity, and inability to raise the heel while standing on the affected foot. Diagnostic imaging with x-rays, ultrasound and MRI will further evaluate the extent tendon injury and the resultant bone and joint changes.
Acute phase treatment includes rest, ice, immobilization and anti-inflammatory medication. Chronic inflammation is treated with physical therapy, orthotics, bracing (Arizona brace), and high-topped shoes. Surgical intervention may be required to repair the degenerated tendon and/or address the underlying faulty mechanics associated with the flat foot.
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