The posterior tibial tendon is located on the inside of your ankle and plays a major role in supporting and maintaining the arch on the bottom of the foot. Due to the high demands of the tendon with every day life, it can result in overuse of the tendon. This overuse is referred to as posterior tibial tendon dysfunction. When this occurs, patients will eventually develop a flat foot deformity and loss of arch height due to the weakened tendon no longer being able to support the arch. This condition is commonly seen in middle-aged women. Those with diabetes also have an increased risk.
The major problem with posterior tibial dysfunction is that it is a progressive disorder. This means that it will get worse overtime. The initial symptoms of the condition are pain and tendonitis; however there is normally no decrease in strength of the tendon or loss of arch at this stage. As it worsens, the tendon will develop tears and the patient will eventually end up with a decrease in the arch height and a flat foot. With early diagnosis, the progression can normally be slowed, or halted, through the use of orthotics, bracing, immobilization and physical therapy. If the dysfunction is left untreated, or progresses, then it may eventually have to be treated with surgical intervention.
–Dr. Colleen Law
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The posterior tibial tendon attaches the tibialis posterior, a muscle deep in the back of the lower leg, to the metatarsal bones. As one of the major supporting structures of the foot, we could not walk without the tibialis posterior. It goes figure that the onset of posterior tibial tendonitis can be painful and impair walking, running, and other activities.
Posterior tibial tendonitis and tendonosis occur when the tendon undergoes stress, inflames or gets small tears in it, which, in turn, impairs the tendon’s ability to support the arch of the foot. Most commonly this is a result of overuse and inconsistent activity after already having the tendency to pronate excessively or a preexisting flatfoot. Once the posterior tibial tendon tears, PTTD is also referred to as “adult acquired flatfoot,” as the condition usually occurs in adulthood. Posterior tibial tendonitis and tendonosis is a progressive disorder, so catch symptoms early by consulting your local Charlottesville or Waynesboro podiatrist. If you feel pain along the course of the tendon or on the inside of the foot and ankle, notice swelling, redness, a warm sensation, a flattening of the arch or inward rolling (pronation) of the ankle consult your podiatrist for a diagnosis or treatment. In more advanced stages, the arch will begin to flatten, changing the dynamic of the foot and your stride as you walk or run. Your toes will turn outward while your ankle rolls inward, pain will shift to the outside of the ankle, and the injured foot, even the ankle, may develop arthritis.
For advanced cases, surgery will be required. However, early treatment will include NSAIDs, icing, shoe modifications, bracing or orthotic devices, immobilization by a short-leg cast or brace that allows the tendon to heal, and avoiding weight-bearing activities for some time. Physical therapy exercises and treatment will include ultrasound therapy and exercises to strengthen and increase the flexibility in the tendon and attached muscles.