Posterior Tibial Tendon Dysfunction (PTTD) - Adult Acquired FlatFoot

Flattening of the arch, rolling in of the foot and ankle, swelling of the inner foot and ankle and the foot is painful.  PTTD is progressive in nature and needs to be treated.

Cause:
This occurs due to an overuse of the tendon.  One will have changes to the tendon due to weakening or tearing of the posterior tibial tendon.  The tendon does not function properly so it cannot support the arch and the foot collapses. 

Symptoms:
Pain, tenderness, inflammation, swelling, weakness of the inside of the foot and ankle.  The arch and inner ankle will flatten.  Overtime the foot will collapse more and more and make it difficult and painful to walk. 

Examination:
The Podiatrist would order an xray also Ultrasound and/or MRI.  Evaluation of the foot and ankle is performed by the Podiatrist testing muscle strength both on the exam table standing and walking.  Always compare the affected to non-affected foot.  The Podiatrist will have the patient stand on the painful foot with the other foot in the air and ask the patient to heel raise.  In performing this test this can be painful or the patient can be unable to do the heel raise and or cannot turn in (invert) the heel.  Depending on the inability to invert the heel and strength of the tendon different treatment options would be chosen. 

Treatment:
The patient may be casted non or weight bearing, crutches.  Physiotherapy, strengthening exercises, anti-inflammatories would be recommended.  If the tendon is not torn the Podiatrist would cast the feet for custom molded foot orthotics with special accommodations eg. an inner arch flare of the orthotic and additional arch padding.  An ankle foot orthosis may be prescribed, which is a foot orthotic combined with an ankle brace.  The ankle brace is available  off the shelf called Aircast Airlift PTTD Brace.  Proper wide supportive shoes are prescribed.  If the tendon is torn or there is non or limited function of the posterior tibial tendon or the deformity continues to progress while being treated with conservative treatment then surgery would be considered.