Posterior Tibial Tendon Dysfunction (PTTD)

PTTD

This is one of the most common tendon dysfunction in the foot and ankle. This happens when the PT (Posterior Tibial Tendon) becomes inflamed or torn. When this happens the tendon is unable to provide support to the arch. Patients may notice arch collapse.

Anatomy:

The posterior tibial tendon is one of the most important tendons in the foot. It helps to not only provide structure to the arch but function in plantarflexion and supination of the foot. This is necessary for normal gait. The tendon originates in the leg and inserts on to the midfoot bones. 

Causes:

Tight Calf Musculature– This causes strain on the PT tendon causing inflammation

FlatFeet– Flat feet put extra strain on the PT tendon causing eventual tearing and dysfunction

Improper shoe gear– Shoes that don’t provide support to the arch can cause extra stress on the tendon

Strenuous exercise

Trauma– Sprains or twisting injury can push this tendon beyond its maximum length

Arthritis– Arthritic changes can limit range of motion and increase the stress on the tendon

Symptoms:

Arch Collapse

Pain, swelling, Bruising and tenderness along the course of the tendon

Pain with range of motion 

Pain with walking barefoot

Inability to supinate and plantarflex the foot

Negative heel rise test

Treatment:

X-ray MRI Ultrasound imaging may be performed: This helps to localize the area of injury and identify bony foot deformity that may be causing the tendonitis

Conservative treatment: 

The goal of this conservative therapy is to get rid of the inflammation and take stress off the injured tendon. This is done by Rest, Elevation, Ice, Compression, Custom molded orthotics, Cam walker boot. At laser foot surgery centers we use Amniotic Injection Therapy : This contains growth factors and stem cells which can help repair the tendon and prevent surgical intervention.

Surgical Treatment:

 For those patients that have failed conservative therapy of present with acute rupture of the tendon, surgical intervention is warranted. Patient will need direct debridement and repair of the tendon. Along with this patients may require reconstruction of the foot to address the bony cause of the tendonitis. Patients are placed in a below the knee cast or cam walker for 6 weeks. Patients will require physical therapy to regain function and mobility.