Posterior Tibial Tendon Dysfunction (PTTD)

Posterior Tibial Tendon Dysfunction (PTTD)

What is Posterior Tibial Tendon Dysfunction (PTTD)?

Posterior Tibial Tendon Dysfunction (PTTD) or known as Adult Acquired Flat Foot is a progressive flat foot condition that causes pain in the ankles or the arch. It is due to inflammation, tear, or degeneration of the Posterior Tibialis Tendon. This tendon runs from the back of our lower leg and attaches to the navicular bone, and it is responsible for supporting and raising our arch when we stand or walk.

Patients with PTTD will experience pain and swelling along the inner side of the ankle or the arch region during standing or walking. They will also have trouble standing on their toes or balancing on one foot. The condition can progress to developing severe flat foot deformity if left untreated.

Causes of PTTD

PTTD is caused by increased stress on the Posterior Tibialis tendon, particularly during standing, walking, and jumping. These movements generate a downward traction force on the tendon, resulting in overuse and injury.

Individuals with flat feet or born with an additional navicular bone (os naviculare) are predisposed to developing PTTD as their foot structure is naturally putting the Posterior Tibialis tendon under high downward traction.

Risk factors of PTTD

Risk factors of PTTD include:

  • Age and gender (women above 40 are more likely to develop PTTD)
  • Obesity or high BMI
  • History of ankle joint injury or surgery
  • Sudden increase in physical activity (e.g Running, Jumping)
  • Flat Feet (Pes Planus)
  • Joint Hypermobility
  • Born with accessory navicular bone (os naviculare)

Signs and Symptoms of PTTD

PTTD is a progressive condition, and it is classified into different stages based on the signs and symptoms, and physical examination.

Signs and symptoms of PTTD include:

  • Pain, redness and swelling of the inner side of the ankle (medial ankle)
  • Pain over the arch region (navicular bone region)
  • Pulling pain over the medial ankle
  • Pain during activity or after prolonged periods of standing or walking
  • Unable to stand on your toes
  • Unable to balance on one foot easily
  • Progressive flat foot changes (e.g ankle rolling inwards, foot or toes pointing outwards)

PTTD Treatment

The treatment of PTTD is dependent on the stage of the condition. As the stage of the condition becomes more advanced, the treatment and rehabilitation process becomes tedious. Early detection and treatment are imperative to prevent severe foot deformity.

Treatment options for PTTD include:

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