Post Tibial Tendon Dysfunction

The post tibial tendon's purpose is to keep the arch in its position and provide support when walking. The tendon passes down the back of the leg, inside of the ankle and under the foot. The tendon can become inflamed (tendinitis) or torn due to overuse, high-impact sports, and falls. The ankle can become unstable and result in loss of arch support over time causing flatfoot deformity. Pain increases with activity and typically occurs at the tendon location with swelling of the ankle. As the arch collapses, pain may develop along the lateral ankle due to the eversion of the foot. If treated early in the course of PTTD, patient's symptoms can improve.

There are four stages of this disorder. Stage I may show signs of swelling, but radiographs show no signs of dysfunction. Generally patients do not have many symptoms at this stage. In stage II, patients present with an increased flattening of the medial arch. The post tibial tendon becomes elongated with increased inflammation. This leads to the "too many toes" sign where more than one to one and a half toes are seen from looking at the heel from the back of the patient. The patient will begin to struggle with doing toe rises. In stage III, the tendon is considerably weak and with a rigid hindfoot with little to no motion of the subtalar joint. Arthritis may begin to develop at this time and pain shifts to the lateral side of the foot/ankle due to the flatfoot. At stage IV, the foot is severely flattened with an increased possibility of necrotic ulcerations developing along the collapsed arch. At this stage conservative treatments generally fail and surgical options are limited. 

Pedorthic applications include:

• Properly fitted shoes with a strong medial midsole
• Medial stabilizer
• Medial flare
• Medial wedge
• Rocker soles
• Full length steel shank
• Functional orthotics
  • Deep heel cup to support the ankle
• Possible lift for the affected side due to the collapsed arch