The human foot is one of the most complex structures in the body, comprising dozens of bones, joints, and soft tissues, all working together to support the weight of the body while enabling movement. One of the key supporting structures of the foot is the posterior tibial tendon, a long, thin cord that runs down behind the inside of the ankle, through the foot arch, and connects to bones in the middle of the foot. The posterior tibial tendon helps hold the arch up and provides support when stepping off on your toes when walking.
However, like any other part of the body, the posterior tibial tendon can experience problems, leading to a condition called Posterior Tibial Tendon Dysfunction (PTTD), also known as adult-acquired flatfoot. PTTD is a condition that is caused by changes in the tendon, impairing its ability to support the arch. Over time, this results in flattening of the foot, leading to pain, swelling, and other symptoms.
PTTD usually occurs in one foot, but some people may develop it in both feet. It is usually progressive, which means it will keep getting worse, especially if it isn’t treated early. If left untreated, PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities.
The most common cause of PTTD is overuse of the posterior tibial tendon. The symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs. People who are overweight, diabetic, or hypertensive are particularly at risk.
Symptoms of PTTD include gradually developing pain on the outer side of the ankle or foot, loss of the arch and the development of a flatfoot, pain and swelling on the inside of the ankle, tenderness over the midfoot, especially when under stress during activity, weakness, and an inability to stand on the toes.
If diagnosed and treated early enough, PTTD can be managed non-surgically. Treatment may include orthotic devices or bracing, immobilization with a short-leg cast or boot, physical therapy, ultrasound therapy, exercises, shoe modifications, and medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation.
However, in cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Your foot and ankle surgeon will determine the best approach for you.
It is crucial to seek medical advice as soon as possible if you experience any of the symptoms of PTTD. Dr Gilbert Huang DPM is an experienced foot and ankle surgeon who specializes in diagnosing and treating conditions like PTTD. With proper care, most people with PTTD can recover and regain their foot function, so they can walk, run, and enjoy other activities without pain or discomfort.