Flat Feet: Posterior Tibial Tendon Dysfunction (PTTD)

In this blog and following this month’s focus on arch pain, I would like to take a moment to discuss PTTD, often known as acquired adult flat foot deformity. The tibialis posterior is a key muscle in the lower leg that is responsible for inversion of the foot but more importantly it supports the medial arch of the foot, preventing any collapse.

A tendon is a tough fibre that connects muscle to bone. Tendon injuries can arise from sudden trauma, such as a ruptured Achilles tendon, however most tendon injuries occur due to multiple tiny tears in the tendon that happen over time from overuse.

PTTD is a caused by damage to the tibialis posterior tendon, preventing its ability to support the arch and often resulting in flattening of the foot. PTTD can happen in either one foot or both feet and tends to worsen if left untreated. Over time this tendon might begin to stretch, rendering it much more difficult to hold up the arch of your foot. PTTD may start off as tibialis posterior tendinitis/tendinopathy, where the tendon is inflamed, and may worsen over time if left untreated.

Symptoms of PTTD

Symptoms often include pain around the arch of the foot and on the inside of the ankle, sometimes radiating through to the inside shin region. Pain is often worse in the mornings and after extended periods of rest, and typically warms up after the first few steps. You might also find that your foot posture appears flatter than prior to your injury.

Who is at risk of PTTD?

Like most tendon injuries, PTTD is often caused by overuse/overloading of the tibialis posterior muscle. Overuse can arise from the following reasons:

  • Training errors/overload, particularly from walking, running or hiking.
  • A period of undertraining followed by returning to previous training loads.
  • Wearing footwear with insufficient support over an extended period of time.
  • Having a pronated foot posture.
  • Hill running.
  • Changes in training surfaces.
  • Tight posterior leg muscles.

How can I treat my PTTD?

At TFC Podiatry our primary mode of treatment for PTTD is the use of custom foot orthoses. Orthotics work really well in offloading the tibialis posterior tendon, realigning the foot and ankle into a more stable position and preventing any further arch collapse. In order to compliment this treatment we also offer:

  •   Rehabilitation of the tibialis posterior muscle, followed by strength and conditioning.
  •   Proprioception exercises.
  •   Shockwave therapy
  •   Dry needling
  •   Strapping and padding
  •   Footwear advice
  •   Training modifications followed by return to sport/exercise.

Surgical intervention may be required in some of the more severe cases of PTTD. In these cases a referral to a surgeon can be implemented.

If you think you may be suffering from flat feet and would like to get it checked out, the podiatrists at TFC Podiatry can help you. The podiatrists at TFC Podiatry are qualified in conducting a thorough investigation and diagnosing PTTD. During a consultation we will assess your footwear, exercise history, injury history, walking foot posture and foot biomechanics, muscle strength and joint range of motion. These assessments will help us diagnose and identify any potential risk factors you may have for developing PTTD and any other foot injuries.

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