Common Conditions

Tibialis Posterior Tendonopathy ( PTTD )

The tibialis posterior tendon is a large tendon connected to the posterior tibialis muscle which is located on the inside of the calf. The tendon comes around the inside of the ankle and inserts into the arch of the foot. The posterior tibialis tendon is responsible for maintaining the arch of your foot and because of its function it is susceptible to trauma and injury.

Posterior tibial tendon dysfunction (PTTD) is a condition where there is an over use of the posterior tibial tendon and this usually presents with pain and swelling on the inside of the ankle. The posterior tibial tendon can over stretch and elongate when weight bearing causing micro trauma and swelling of the tendon, damaging the tendon structure. This causes ankle weakness and can cause a collapse of the arch and foot profile. PTTD is the main cause of the Adult Acquired Flat Foot Deformity.

PTTD classification by stages

Stage I Stage II Stage III Stage IV
Tenosynovitis or degeneration of the tendon

Pain

No deformity

Mild weakness (able to complete single heel rise with inversion of hindfoot)
Elongation and degeneration of the tendon

Pain

Flexible pes planovalugus deformity

Forefoot abduction when weightbearing

Significant weakness (no or limited inversionof hindfoot in single heel rise)
Elongation and degeneration of the tendon

Pain

Flexible pes planovalugus deformity

Forefoot abduction when weightbearing

Inability to perform a single leg heel rise
Same presentation as stage 3 with inclusion of:

Valgus deformity of the talocrural joint

Arthritis of the ankle

Signs and symptoms of PTTD

  • Ankles rolling in.
  • Pain around the inside of the ankle.
  • Swelling around the inside of the ankle.
  • Weakness in the ankle.
  • Unable to complete a single leg tip toe.
  • Pain on the outside of the ankle (sinus tarsi).
  • Arthritis of the ankle.

Treatment options

During an initial consultation with your Podiatrist, they will establish if you have PTTD and discuss the specific treatment programme for your condition. Treatment may consist of:

  • NSAID’s.
  • Heat and ICE therapy.
  • Advanced Analysis.
  • Orthoses.
  • Strapping.
  • Rehabilitation.
  • Footwear advice.
  • Aircast brace.
  • Richie Brace.
  • Training modification.
  • Imaging including X-ray, MRI or ultrasound can also be usefu.