Posterior Tibial Tendon Dysfunction (PTTD) is a condition that affects the posterior tibial tendon, which plays a crucial role in supporting the foot while walking. When this tendon becomes damaged—through inflammation, tears, or overstretching—it can lead to significant pain and functional impairment. However, with appropriate treatment, the symptoms of PTTD can be managed, and foot function can often be restored with the help of a skilled podiatrist.

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Causes of Posterior Tibial Tendon Dysfunction (PTTD)

PTTD typically occurs when the posterior tibial tendon becomes inflamed (tendonitis) or injured. Several factors can contribute to this, including:

  • Age: As we age, tendons lose their elasticity, increasing the risk of dysfunction.
  • Inflammatory diseases: Conditions such as Reiter’s syndrome, rheumatoid arthritis, and psoriasis can contribute to tendon inflammation.
  • Diabetes: This can affect tendon health and healing.
  • Foot trauma or injury: Previous injuries to the foot or ankle can increase the risk of developing PTTD.
  • Hypertension and obesity: Both can negatively affect tendon health and contribute to the progression of PTTD.
  • Ill-fitting shoes: Especially high heels or shoes that do not support the foot properly, which can place excess strain on the tendon.
  • Athletes: People who engage in sports are at higher risk due to frequent foot injuries.

Symptoms of Posterior Tibial Tendon Dysfunction

The symptoms of PTTD can vary in severity, but common signs include:

  • A bulge in the outer side of the foot or ankle: The tendon can cause swelling or a visible bulge.
  • Difficulty standing on the toes: The posterior tibial tendon is crucial for raising the heel, so dysfunction can lead to weakness or difficulty with this motion.
  • Loss of the foot’s arch: The posterior tibial tendon helps maintain the arch of the foot. Dysfunction can lead to a collapsed arch.
  • Pain in the foot and ankle: The pain is typically located along the inner side of the foot or ankle.
  • Pain in the arch of the foot: As the tendon weakens, pain can occur in the arch, leading to discomfort when walking or standing for prolonged periods.

Treatment of Posterior Tibial Tendon Dysfunction

Treatment for PTTD depends on the severity of the condition and how far it has progressed. There are both non-surgical and surgical treatment options available:

Non-Surgical Treatment

For early stages of PTTD, conservative treatments are typically recommended:

  • Non-steroidal anti-inflammatory drugs (NSAIDs): These medications help reduce inflammation and relieve pain.
  • Immobilization: Using crutches or orthotic supports (like custom-made insoles) can relieve pressure from the tendon, allowing it to heal.
  • Physical therapy: Stretching and strengthening exercises can help support the tendon and improve mobility.

Surgical Treatment

In more advanced stages, when the tendon is severely damaged or if non-surgical methods fail, surgery may be necessary. Surgical interventions can include:

  • Tendon repair: Removing damaged tissue and repairing the tendon.
  • Bone realignment: In some cases, the bones in the foot may need to be realigned to support the tendon.
  • Bone grafting: If the tendon damage is severe, bone grafts may be used to repair or reconstruct the damaged area.

Conclusion

If you’re experiencing symptoms of posterior tibial tendon dysfunction or suspect you might have the condition, it’s essential to seek medical advice from a podiatrist. Early diagnosis and treatment can significantly improve outcomes and restore function. With the right approach, you can manage the symptoms and maintain a high level of foot health.