Posterior Tibial Tendon Dysfunction

After running the Melbourne Marathon in 2021 I suffered a chronic injury to both of my feet called posterior tibial tendon dysfunction. Today I’m going to write about this injury and how to successfully treat it.

Posterior tibial tendon dysfunction (PTTD) is a common foot and ankle injury to the tibial tendon where it becomes inflamed or torn, which may result in adult acquired flat foot deformity if left untreated. PTTD occurs from a result of overuse to the posterior tibial tendon causing inflammation and microtrauma.

Common symptoms of PTTD include:

  • Pain along the inside of the arch of the foot and medial ankle
  • Weakness or inability to complete a single leg calf raise
  • Pain worsens with high impact activities such as running or jumping
  • A collapsed arch in some cases
  • Swelling along the inside of the ankle and arch

Risk factors

There are a number of risk factors that can increase your likelihood of developing PTTD. When I developed PTTD it was likely due to a combination of having an accessory navicular bone, my foot posture, and increasing my training load too quickly when building up for the marathon. Let’s take a look at some of the most common risk factors below:

  • Pes planus foot posture
  • Having an accessory navicular bone
  • Obesity
  • Diabetes
  • Hypertension
  • Training overuse from exercise involving running or jumping

Treatment of Posterior tibial tendon dysfunction

Treatment of PTTD can take 3-6 months depending on severity. Most patients are able to be successfully treated with nonsurgical treatment. Such methods include:

  • Rest from weightbearing exercise for 6-8 weeks
  • Offloading of the posterior tibial tendon.
    Some offloading techniques include the use of custom foot orthotics, ankle braces and in some cases, a CAM walker. Your podiatrist will determine which is the best option for you.
  • Calf and hamstring stretches initially, followed by strengthening exercises to improve tendon and muscle strength.

If conservative management fails to treat the injury after 6 months then surgical intervention may be required. In some cases certain medications, such as nonsteroidal anti-inflammatory drugs may be advised to help manage pain. However you should always be careful with this method as some medications can have negative side effects.

During treatment of my own injury I took 6 weeks off sport, wore a combination of supportive footwear, custom foot orthotics and ankle braces and focused on plenty of stretching of the lower leg muscles to successfully reduce pain. I still managed to exercise after taking up swimming and cycling, 2 sports which don’t impact the feet. I am now in the process of physical therapy to strengthen my legs back up and will be shortly returning to sport.

If you are concerned you may have PTTD don’t hesitate to book with one of our experienced Podiatrists at our Avondale Heights, Point Cook and Yarraville clinics

Blog by: Jayden Schulz


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