What is Posterior Tibial Tendon Dysfunction?
Posterior tibial tendon dysfunction (PTTD) is the sudden or gradual loss in strength of the tibialis posterior tendon/muscle. The tibialis posterior muscle begins in the back of the lower leg, and its tendon runs around the inside of the ankle and inserts into various areas of the foot. This muscle supports the medial longitudinal arch of the foot, controlling how much and how fast the foot can roll in, or “pronate.”
There are four stages of PTTD (1):
1. Weakness of tibialis posterior muscle
2. Degeneration of the muscle
3. Fixed deformity
4. Arthritic changes
What do people experience?
Symptoms of PTTD can include:
- Pain around the inside of the foot and ankle
- Morning ankle stiffness that initially gets better
- Increased pain with activity
- Decreased walking distance
- Change in foot shape/lowering of the arch
- Feeling of “rolling in”
How To Relieve Symptoms of Posterior Tibial Tendon Dysfunction
Risk factors for discomfort include:
- Flat feet
- Repetitive movement causing strain on the tibialis posterior muscle
- High impact activity
- Increasing age
What are my options for treatment? Who else can help?
Many options are available to you, and vary from conservative to invasive treatments. Often if symptoms are not present, treatment is not necessary. Conservative treatments include exercise, footwear modifications, custom foot orthotics, and bracing. These options are typically used in the earlier stages of PTTD and may be discussed with physiotherapists, kinesiologists, pedorthists, and other healthcare professionals. Medical and surgical interventions are generally used in the later stages of PTTD and may be discussed with your family physician.
Staying active with pain
Staying active with PTTD means being able to support the medial longitudinal arch and reduce the strain on the tibialis posterior muscle enough to reduce symptoms. This can be done in several ways, including choosing more supportive footwear, adding custom offthe-shelf orthoses, and bracing. These devices work in similar but slightly different ways to reduce strain on the tibialis posterior muscle, thus reducing pain during and after activity.
High impact activity can cause a greater amount of strain on muscles than lower impact activity. Choosing low-impact activities can reduce the amount of abrupt movement and strain on the muscles and limit the overall strain on injured structures.