ADULT FLAT FOOT DEFORMITY
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POSTERIOR TIBIAL TENDON DYSFUNCTION
The posterior tibial tendon (PTT) is a critical supporting structure of the foot. The PTT has a large rule in supporting the arch of the foot and helps during the walking (the gait cycle). Dysfunction of the PTT can cause (PTTD) can cause changes in the tendon leading to impairment to support the foot arch and flattening of the foot.
The PTTD is commonly referred to adult acquired flatfoot because it is most commonly seen in adult with flatfoot deformity. The condition usually affect one foot, however, it may develop it in both feet. In many cases, PTTD is progressive deformity that may worsen if it is not treated early.
Causes
PTTD is often caused by overuse of the tendon with symptoms provoked after activities that involve the tendon, such as running, walking, hiking or climbing stairs. Obesity and ill fitting shoes without arch support may contribute to the condition.
Symptoms
The PTTD is a progressive condition. Initially symptoms manifest as pain and swelling along the course of the tendon on the inside of the ankle. This may associates with flattening of the foot.
As condition progress, the foot arch flattens with inward rolling of the ankle and outward turning of the foot. Pain shifts toward the ankle and to the outside of the foot below the ankle as arthritis develop.
Diagnosis
Your physician will initially examine your foot and ankle and evaluate the range of motion of your foot and ankle joints and evaluate the condition of the tendon. An x-rays evaluation and other diagnostic imaging modalities might be considered for further assessment of the tendon.
Treatment
Early diagnosis and treatment is necessary to arrest the progress of the condition and resolve the inflamed tendon.
Untreated PTTD can progress to flat foot, painful arthritis in the foot and ankle and increasing limitations on walking, running or other activities.
PTTD treatment begin with nonsurgical approaches that may include:
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Orthotics or bracing. In order to support the foot arch.
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Immobilization. Avoid all weight bearing activities. Utilize CAM walking boot and sometimes short-leg cast in order to immobilize the foot and allow the tendon to heal.
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Physical therapy. Stretching exercises for cases associated with short achilles tendon can be beneficial. Physical therapy after immobilization and recovery of the tendon, ultrasound therapy and exercises may help rehabilitate the tendon and muscle.
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Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), help reduce the pain and inflammation.
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Shoe modifications. Your physician may advise changing the shoe type and may prescribe custom insert to support the foot arch.
Surgical Intervention
In some cases, non-surgical approach is unsuccessful to prevent the progress of PTTD. The condition advances to arthritis causing further pain and limitations to which surgery may be required. Your physician will determine the best surgical approach based on the condition.