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Posterior Tibial Tendon Dysfunction (PTTD)

Pain from your arch to your calf?

It could be Posterior Tibial Tendon Dysfunction

Posterior Tibial Tendon Dysfunction (commonly known as PTTD) is an injury or weakness of the posterior tibial tendon (PTT).  When the tendon becomes weak it causes other secondary muscles to take over which can cause misalignment in the foot. As this weakness progresses is can cause the medial arch to collapse. Though some cases of the tendon dysfunction do not present pain along with the other symptoms, the weakening of the tendon occurs in stages and often becomes painful.

The posterior tibial tendon is the primary stabilizer of the rearfoot.  This tendon connects your posterior tibial muscles to the bones in your foot. It passes down the back of the leg and then turns underneath the inner side of the ankle and attaches to a bone of the inner side of the foot near the arch.  As the condition worsens the inflammation, tendonitis, and deformity increase.

Posterior Tibial Tendon Dysfunction (PTTD) can be difficult to detect and often goes unnoticed until severe deformity is present.

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What is PTTD?

Posterior Tibial Tendon Dysfunction is also known as Acquired Adult Flat Foot Deformity (AAFFD) and is generally seen as a collapse of the medial column of the foot.  If you have this dysfunction, you may experience tenderness on the medial (inside) part of the arch. There are multiple stages of PTTD. With each stage the pain usually increases.

The condition is often difficult to detect, and it often goes unnoticed until significant deformity is present.  As the stages of PTTD progress the patient will notice a significant drop in the arch and pain in the foot and ankle.  The condition is most commonly seen in only one foot, but at times does develop in both. The most common occurrence of PTTD is in women over 50, but it can occur with anyone. Symptoms of the condition can include:

  • Pain on the inner side of the foot and ankle Swelling in the posterior tibial tendon
  • Inability to stand on the toes of the affected side
  • Unsteady gait
  • Sharp pains in the arch of your foot
  • Stiffness in your ankle joint

PTTD (Acquired Adult Flat Foot Deformity) can be an increasingly painful condition

Stages of PTTD

Posterior tibial tendon dysfunction is a progressive disorder, meaning that as time goes on the condition can worsen and grow more painful. PTTD can be classified into four stages.

Stage 1: Mild symptoms of tendon weakness with minimal deformity and inflammation. This is a case of mild tendonitis where the tendon is still at a normal length.

Stage 2: Moderate symptoms of tendon weakness with increased deformity and inflammation. Tendonitis in stage two is progressively worse than stage one. Pain is usually present within the main arch (medial longitudinal arch) of the foot.  When in stage two the tendon is slightly elongated.

Stage 3: Considerable weakness because of an elongated posterior tibial tendon.  The deformity of the forefoot and rearfoot become rigid with a drastic collapse of the medial side of the foot (the arch.)

Stage 4: After sustained injury through the first three stages, in stage four you will experience degenerative changes to the ankle joint.

As the tendon degenerates, the arch collapses and can become increasingly painful in the ankle and foot

What Causes PTTD?

There are multiple possible causes of posterior tibial tendon dysfunction. PTTD most frequently affects women over the age of 40, and is triggered by tendon degeneration which breaks down as you get older. PTTD can also affect those with the following conditions:

  • Injury or overuse of the tendon
  • Recent ankle sprain
  • Obesity
  • Diabetes
  • Previous surgery