Posterior tibial tendon dysfunction (PTTD) part 1 – what to look out for

What is PTTD?

The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot.

PTTD is often called adult acquired flatfoot because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it is not treated early.

What causes PTTD?

The posterior tibial tendon usually tears due to overuse. Athletes who play high impact sports such as basketball, or soccer may acquire tears of the tendon from repetitive stress and overloading. An acute injury, such as from a fall, can tear the posterior tibial tendon or cause it to become inflamed. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time.

Symptoms of PTTD

• Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling, redness and warmth in the area.
• Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time.
• Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot.

Examination and diagnosis

Your Podiatrist will take a complete medical history and ask about your symptoms. During examination of the foot and ankle, they will check if the following signs are present:

• Swelling along the posterior tibial tendon. This swelling is from the lower leg to the inside of the foot and ankle.
• A change in the shape of the foot. The heel may be tilted outward and the arch will have collapsed.
• “Too many toes” sign. When looking at the heel from the back of the patient, usually only the fifth toe and half of the fourth toe are seen. In a flatfoot deformity, more of the little toe can be seen.
• “Single limb heel rise” test. Being able to stand on one leg and come up on “tiptoes” requires a healthy posterior tibial tendon. When a patient cannot stand on one leg and raise the heel, it suggests a problem with the posterior tibial tendon.
• The range of motion of the ankle is affected. Upward motion of the ankle (dorsiflexion) can be limited in flatfoot. The limited motion is tied to tightness of the calf muscles.

Your Podiatrist may also refer you to undergo imaging studies such as X-ray, Ultrasound, CT or MRI to assist in the diagnosis of this condition, and to rule out other conditions such as arthritis. If you are having problems with pain in your lower legs and feet, don’t hesitate to call us on 9569 5145 or make a booking online and the team at Sole-Lution Podiatry will sort you out. We are located at 398 Marrickville Rd, Marrickville, NSW, 2204.

Stay tuned for PTTD Part 2 – How to treat PTTD