Conditions We Treat
Posterior Tibial Tendon Dysfunction (PTTD)
What Is It?
PTTD is a progressive condition where the posterior tibial tendon, which helps support the arch of the foot, becomes inflamed or torn. It can lead to adult-acquired flatfoot deformity if untreated. The tendon is vital for maintaining the structural integrity of the medial longitudinal arch.
Symptoms
- Pain and swelling along the inner ankle or arch
- Flattening of the arch (acquired flatfoot)
- Difficulty standing on tiptoes
- Rolling inward of the ankle (overpronation)
- Fatigue or aching in the foot or leg after prolonged standing or walking
Diagnosis
- Observation: Collapsed arch or heel that doesn’t invert when rising on toes
- Physical exam: Tenderness and weakness along the tendon; single-limb heel raise test
- MRI or ultrasound: Confirms tendon damage, thickening, or degeneration
- X-rays: Assess foot alignment, joint spacing, and bony changes
Treatment
Conservative Options:
- Orthotics or custom braces (e.g., Arizona brace) to support the arch
- NSAIDs for inflammation and pain
- Physical therapy: Strengthening of the posterior tibialis and gait training
- Activity modification: Reducing high-impact stress on the foot
Surgical Options:
- Surgical repair or reconstruction in advanced cases or failed conservative care, often involving tendon transfers or osteotomies
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