Posterior tibialis tendon dysfunction (PTTD): Symptoms and solutions

Posterior tibialis tendon dysfunction (PTTD) is a prevalent condition that affects the foot and ankle, characterised by the gradual degeneration, inflammation, or tearing of the posterior tibialis tendon.

Here, Mr Shelain Patel, renowned consultant orthopaedic foot and ankle surgeon, offers his expert insight into the intricate facets of PTTD, exploring its symptoms, diagnostic approaches, and a variety of treatment modalities.

What is PTTD, and what are its common symptoms?

The tibialis posterior tendon is a structure that connects the tibialis posterior muscle to the inside aspect of the foot. It helps to pull the foot down and inwards when sitting, or pull the heel inwards when going up on tiptoes. PTTD refers to swelling and degeneration of this tendon, such that these functions are impaired. Common symptoms include pain and swelling on the inner aspect of the ankle, flattening of the arch of the foot, and tiredness in the foot when walking long distances.

What causes PTTD, and are there any risk factors involved?

There is no one single cause of PTTD, but many factors have been implicated. These include severe ankle sprains, being overweight, and pre-existing flat feet.

How is PTTD diagnosed, and what treatment options are available?

A combination of history, examination, and MRI scanning will help diagnose PTTD. Treatments vary depending on the severity of the condition, and range from supportive measures (such as insoles and footwear suggestions) to physiotherapy to operations.

Is surgery necessary for PTTD, and what does the recovery process involve?

Surgery is needed in patients whose pain and dysfunction cannot be controlled with non-operative means. Recovery will depend on the type of surgery involved. In most cases, there will either be cutting of bones (osteotomy) or fusions of joints (arthrodesis), then coupled with tendon releases or transfers to get the foot functional. Plaster casts are needed to hold the foot in the correct position and once the bones are healing, a pneumatic walking boot and physiotherapy can be used. The recovery period can take many months and sometimes up to one year.

Can PTTD be managed with non-surgical approaches, such as physical therapy or orthotics?

Non-surgical treatment forms the basis for more than 90% of patients with PTTD. Physical therapy will help strengthen the muscles around the ankle to reduce the workload on the posterior tibial tendon. Meanwhile, although orthotic aids typically do not re-form a patient’s flattened arch, using a medial arch insole or specialist PTTD brace can support the foot to reduce any excess strain on the tendon.

If you would like to schedule an appointment with Mr Shelain Patel, head on over to his Top Doctors profile today.