Tibialis Posterior Tendonopathy ( PTTD )
The tibialis posterior tendon is a large tendon which arises as a muscle on the inside of the calf and becomes a tendon around the inside of the ankle, which then inserts into the arch. This tendon is responsible for maintaining the arch of your foot and is susceptible to trauma and injury.
Posterior tibial tendon dysfunction ( PTTD ) is an over use of the posterior tibial tendon, where patients develop ankle pain along the inside of the ankle. The posterior tibial tendon can stretch and elongate, and microtrauma within the tendon can occur, which damages the tendon’s structure. The arch can collapse and further extensive musculoskeletal disorders can occur if it is left untreated and unmanaged. PTTD is the main cause of “adult acquired flat foot”.
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 / ice.
- Temporary insoles.
- Strapping.
- Rehabilitation.
- Footwear advice.
- Air cast boot.
- Training modification.
- X-ray, MRI or ultrasound can also be useful.
