Foot Conditions A-Z
Posterior Tibial Tendon Dysfunction (PTTD)
Also called “adult-acquired flat foot,” PTTD occurs when inflammation or damage to the posterior tibial tendon reduces its ability to support the arch. This often results in flattening of the foot, meaning the entire foot touches the floor when you’re standing. Although PTTD usually occurs in only one foot, some people may develop the condition in both feet. It typically will continue to get worse, particularly if it is not treated early.
PTTD is not the same as pes planus, a generic form of flat feet that has a strong hereditary component. PTTD is not hereditary; it is due to a variety of factors described in the next section.
PTTD is more common in women and in people over age 40. Symptoms may include the following:
- Pain on the inside of the foot and ankle where the tendon runs (sometimes associated with swelling in the area).
- Pain that increases with activity. High-intensity/high-impact activities such as running can cause this pain; some people may have trouble walking or standing for long periods.
- Pain on the lateral side (outside) of the ankle. As the foot collapses, the heel bone may shift to an everted (outward) position, which puts pressure on the outside ankle bone.
PTTD can be caused by the following:
- Acute injuries from, among others, a fall or athletic activity that tears the posterior tibial tendon or causes it to become inflamed. People who participate in high-impact activities such as basketball, soccer and tennis are particularly at risk.
- Overuse – over time the tendon may become inflamed or torn, and the arch slowly collapses.
- Obesity and pregnancy put stress on the arches and tendons, causing the arches to flatten.
- Degeneration from systemic disorders such as rheumatoid arthritis, diabetes and hypertension.
Prevention and Treatment
Preventive strategies include the following:
- Warming up and stretching prior to or immediately following engaging in sports and activities. For specific advice on when to stretch, consult your physician or foot care specialist.
- Keeping leg muscles strong to help prevent injuries to the lower limbs.
- Use of orthotics to support the medial longitudinal arch.
- To help prevent PTTD and help ensure that your feet are optimally protected, IPFH suggests that you wear only properly selected and fitted, as part of an integrated approach, padded socks with shoes with non-slip outsoles and any inserts or orthotics prescribed or recommended by a doctor or foot health professional. Peer-reviewed, published studies have shown that wearing clinically-tested padded socks can help protect against injuries to the skin/soft tissue of the foot.
Treatment involves conservative measures such as the following, which should be tried first:
- Rest and cutting back on activities that worsen the pain.
- Foregoing high-impact exercise and changing to low-impact exercise such as bicycling, elliptical training or swimming.
- Icing the affected area.
- Taking anti-inflammatory medications, if tolerated.
- Wearing padded socks with orthotics or braces.
- Physical therapy to help strengthen the tendon.
For more serious cases, your doctor may prescribe a cast or walking boot, which allows the tendon to rest and the swelling to diminish. A steroid injection may be given to reduce pain, but only if less invasive therapy is not effective. The option of last resort is surgery, which usually is done only if pain persists after six months of less-invasive treatment. The type of surgery depends on where and to what extent the tendon is inflamed or damaged.
PTTD and fallen arches can have an impact on the entire musculoskeletal system by changing your gait. This causes the body to compensate by inappropriately using other muscles and joints, which often results in pain and injury to the knees, hips, spine and other areas of the body.
It is important to seek medical attention for persistent pain in the inside ankle area. Always talk to your doctor if you have soreness, pain, redness, swelling or other indications of problems in any area of your feet that persist for more than a few days.