Posterior Tibial Tendon Dysfunction: Causes, Symptoms, Treatment, and Rehabilitation

What is the Posterior Tibial Tendon?

The posterior tibial tendon connects the posterior tibial muscle in the lower leg to the bones of the inner foot. This tendon plays a critical role in:

• Arch Support: Maintaining the arch of the foot.

• Foot Stabilization: Providing stability during walking and running.

• Weight Bearing: Helping the foot adapt to weight-bearing activities and uneven surfaces.

When the tendon is overused, injured, or degenerates over time, it can lose its functionality, leading to PTTD.

Causes of Posterior Tibial Tendon Dysfunction

PTTD can result from several factors, including:

• Overuse or Repetitive Strain: Prolonged stress on the tendon from activities like running or walking long distances.

• Acute Injury: Direct trauma or a sudden twisting motion can lead to tendon damage.

• Age-Related Degeneration: As we age, tendons naturally weaken, increasing the risk of dysfunction.

• Foot Abnormalities: Pre-existing conditions like flat feet can place excessive strain on the posterior tibial tendon.

• Chronic Conditions: Diseases such as rheumatoid arthritis or diabetes may predispose individuals to tendon dysfunction.

Symptoms of Posterior Tibial Tendon Dysfunction

The symptoms of PTTD often progress in stages and may include:

1. Early Stage Symptoms:

   • Pain and swelling along the inside of the ankle or lower leg.

   • Difficulty standing on tiptoes.

   • A feeling of instability or weakness in the foot.

2. Progressive Symptoms:

   • Flattening of the medial arch, causing the foot to roll inward (overpronation).

   • Visible changes in foot shape, leading to flatfoot deformity.

   • Pain along the outside of the ankle, as other tendons are strained to compensate.

3. Advanced Symptoms:

   • Chronic pain, stiffness, and swelling.

   • Difficulty walking or standing for prolonged periods.

   • Limited mobility and impaired function.

Diagnosis of Posterior Tibial Tendon Dysfunction

A healthcare provider will perform a comprehensive evaluation to diagnose PTTD, which may include:

• Physical Examination: Assessment of foot and ankle structure, arch height, and range of motion. Tests may include:

  • Single-Limb Heel Rise Test: Difficulty or inability to stand on tiptoe is a common indicator.

  • Observation of Foot Shape: Identifying flattening of the arch or inward rolling of the ankle.

• Imaging Studies:

  • Ultrasound: Identifies tendon tears or inflammation.

  • MRI: Provides detailed images of tendon damage or degeneration.

  • X-Ray: Assesses changes in bone alignment due to advanced flatfoot deformity.

Treatment for Posterior Tibial Tendon Dysfunction

Treatment options vary based on the severity of the condition and may include:

Non-Surgical Treatment:

1. Rest and Activity Modification:

   • Reducing or avoiding activities that exacerbate symptoms, such as running or prolonged standing.

2. Orthotics or Braces:

   • Custom Orthotics: Support the arch and relieve strain on the tendon.

   • Ankle-Foot Orthosis (AFO): Provides additional support and stability in advanced cases.

3. Physiotherapy:

   • Strengthening Exercises: Focused on improving the strength of the posterior tibial tendon and surrounding muscles.

   • Stretching Exercises: Address tightness in the Achilles tendon or calf muscles.

   • Proprioceptive Training: Improves balance and reduces compensatory movement patterns.

4. Anti-Inflammatory Medications:

   • NSAIDs (e.g., ibuprofen) can reduce pain and inflammation.

5. Ice Therapy:

   • Applying ice packs to the affected area can alleviate swelling and discomfort.

Surgical Treatment:

Surgery may be necessary for severe cases of PTTD, particularly if non-surgical methods fail. Options include:

• Tendon Repair or Transfer: Repairing or replacing the damaged tendon using a healthy tendon from another part of the foot.

• Flatfoot Reconstruction: Realigning the bones and restoring the arch structure.

• Arthrodesis (Joint Fusion): Fusing joints to stabilize the foot and reduce pain in advanced cases.

Rehabilitation for Posterior Tibial Tendon Dysfunction

Rehabilitation is essential for recovering strength, mobility, and function. At Palms Physiotherapy & Allied Health, we offer tailored programs that include:

• Pain Management: Techniques like massage and electrotherapy to reduce discomfort.

• Strengthening Exercises: Gradual strengthening of the posterior tibial tendon and surrounding muscles.

• Stretching and Mobility Work: Restoring flexibility and range of motion in the foot and ankle.

• Functional Training: Helping patients return to daily activities or sports with improved foot mechanics and stability.

Preventing Posterior Tibial Tendon Dysfunction

You can reduce your risk of developing PTTD by:

• Wearing Supportive Footwear: Choose shoes with good arch support and cushioning.

• Maintaining a Healthy Weight: Reducing stress on the feet and tendons.

• Strengthening and Stretching: Regularly exercising the foot and ankle muscles to maintain strength and flexibility.

• Listening to Your Body: Avoid overuse by gradually increasing activity levels.

Posterior Tibial Tendon Dysfunction can be debilitating if left untreated. With early intervention and a comprehensive treatment plan, most individuals can manage symptoms effectively and avoid surgery. Contact Palms Physiotherapy & Allied Health today to begin your recovery journey with expert guidance and care.