Posterior Tibial Tendon Dysfunction (PTTD)
Posterior tibial tendon dysfunction (PTTD) is also referred to as adult acquired flatfoot. This condition occurs when there are degenerative changes to a major tendon of the foot, impairing its ability to support the arch, which results in a flattening of the foot. It is one of the more common foot and ankle problems and a torn or inflamed tendon is often the catalyst for affliction.
PTTD is the most common cause of fallen arches in adults and while it typically strikes only one foot at a time there are several cases where it has developed in both feet simultaneously. It is considered a progressive affliction, which means that it worsens with time, particularly if treatment is not introduced early on.
Symptoms of posterior tibial tendon dysfunction may include pain, swelling, a fallen arch on the afflicted foot, and inward pronation of the ankle. Pain often intensifies during physical activity and may linger for a short period of time after activity has ceased. If initial symptoms aren’t treated pain on the inside of the foot and ankle may intensify and the skin may become red, warm and swollen. If left untreated after symptoms progress arthritis will likely develop in the foot and if this is left untreated the ankle may become affected as well.
Overuse is one of the most common causes of PTTD and symptoms frequently present after strenuous activities that involve the tibial tendon, such as hiking, running, walking and ascending steep grades such as a hill or a staircase. Acute injuries from falling or other forms of impact can also cause inflammation or tears within the tendon. High-impact sports such as basketball, tennis, soccer and certain forms of dance may causes gradual tears from long-term repetitive use. The arch of the foot may gradually collapse over an extended period of time once tearing or inflammation occurs.
Women are more affected by this condition than men, and it occurs most frequently in populations that over forty years of age. People suffering from diabetes, hypertension, or obesity are at increased risk for developing PTTD.
Because PTTD is classed as a progressive condition early treatment is best, as symptoms can likely be resolved without surgical intervention. If left untreated, however, treatment becomes much more complicated and invasive.
Initial treatment often involves rest and cold therapy as well as a reduction or complete cessation of all physical activities. More extensive intervention than this is often required however. Conservative treatments usually include the use of orthotic devices, braces, immobilization of the foot through leg casts or boots, physical therapy, anti-inflammatory medications and a modification to the patient’s footwear.
Most cases of PTTD can be resolved through non-invasive treatment but if the condition has substantially deteriorated or if conservative treatments have failed to improve symptoms or reduce pain levels then surgery may be required. Surgical procedures often entail removing inflamed tissues or repairing tears to the tendon, but because the surgery for posterior tibial tendon dysfunction is complex and highly involved patients often experience reduced mobility and longer healing times than may be desired.