Posterior Tibial Tendon Dysfunction (PTTD): Painful Flat Foot

Posterior Tibial tendon dysfunction (PTTD) is a painful and progressive condition where there is an inflammation or rupture in a major tendon called the posterior tibial tendon. This tendon functions to support the arch of the foot and overtime, PTTD causes the foot to flatten. Most often PTTD occurs from overusing the tendon through physical activities such as running, walking, hiking or climbing stairs. Patients may experience symptoms of swelling, flatting of the foot, and medial arch pain especially near the insertion site of the posterior tibial tendon. The heels maybe also turn outward along with the ankles rolling inward.

The following are treatment options that may be considered by your doctor or podiatrist for PTTD:

  • Orthotics or functional bracing to provide your foot with arch support
  • Ice, rest, and immobilization with a below the knee cast/ CAM boot to allow the tendon to heal
  • Shoe modifications to improve the arch support
  • Medications such as NSAIDs to reduce the pain and inflammation
  • Physical therapy

If PTTD is not treated early enough, the condition may continue to worsen and therefore it is important to see your podiatrist to correctly diagnosis and treat PTTD as soon as possible. Your foot doctor may have you perform a single or double heel rise to examine the extent of the PTTD. To also determine if the PTTD is a flexible or rigid deformity, your podiatrist may lift up your big toe while you are weight bearing to test if the medial arch can be recreated. This is called a “Hubscher maneuver.” If after failing conservative treatments as listed above and the PTTD continues to progress further, surgical treatments may be needed to best address PTTD. Your doctor or podiatrist, who is a foot and ankle surgeon, may advise various options such as tendon transfer, osteotomy of bone cuts to mold a arched foot, and/or joint fusion. So if you are suffering from painful flat feet, call your podiatrist today to diagnosis and treat PTTD in order to prevent a permanent PTTD deformity.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office