Understanding Posterior Tibial Tendon Dysfunction

Posterior Tibial Tendon Dysfunction, PTTD, is a painful condition resulting from degeneration and dysfunction of the tendon on the posterior aspect of the ankle. The posterior tibial tendon plays a vital role as an arch support during walking and running. A weakened or damaged tendon makes walking and other activities extremely painful and difficult. Therefore, it is critical to understand this tendon and the role it plays in maintaining balance and functionality in your body.

The most common cause of Posterior Tibial Tenderonis PTTD is age related degeneration. Over time the tendons can weaken and lose elasticity causing a gradual onset of PTTD in the older population. Trauma is another cause of PTTD. An injury to the ankle or foot can cause a rupture or weakening of the posterior tibial tendon, potentially leading to PTTD if the injury is not appropriately managed (Ling and Lui 2017).

Pronation (flatfoot deformity), where the medial and lateral arches collapse into a single, flat surface, can also cause PTTD by placing unacceptible stress on the posterior tibial tendon. Many people are born with this type of flatfoot deformity and other biomechanical factors that can affect the function of this tendon, placing it at risk for injury and subsequent pain and dysfunction.

In addition to intrinsic factors, PTTD can also be influenced by genetic factors and underlying systemic diseases. Some individuals are born with tendon configurations that predispose them to greater risk of injury or degradation, while others may develop PTTD secondary to underlying health conditions such as diabetes or rheumatoid arthritis. Gluck and associates (2010) demonstrated the role of systemic diseases on tendon, elucidating how such conditions could contribute to the onset of PTTD.

Symptoms of PTTD can be obvious and vary among individuals. Typical symptoms and signs of PTTD may include pain on the inner aspect of the ankle and swelling, which make it difficult to place weight on the affected foot. Pain is typically increased with activities of walking and standing for long periods of time, as noted in Kulig et al. ( 2009).

Instability, and difficulty walking and mobility are common symptoms in PTTD. Patients with PTTD complain of walking abnormally and pain on walking. According to Bowring and Chockalingam (2009) this can result in decreased activity and social isolation as people with PTTD often spend most of their time at home.

As PTTD progresses it can dramatically change the shape and function of an individual’s foot leading to obvious alterations in appearance such as a more pronounced flat-arch shape or even a more severe supra-articular everted position. These changes may impede an individual’s ability to ambulate and participate in other activities of daily living, thus detracting from an individual’s quality of life.

Understanding the causes and symptoms of PTTD is critical to treating PTTD. By understanding what causes PTTD, individuals and medical professionals can deal with the debilitating condition and explore different avenues to treatment. Posterior tibial tendon dysfunction (PTTD) is a serious condition that affects many people, causing substantial impairment to daily activities and sports. There are various forms of treatment available for PTTD ranging from conservative to surgical correction.

Conservative treatment of PTTD is generally undertaken first, beginning with orthotics such as arch supports or custom-made foot orthotics that help support the foot and alleviate posterior tibial tendon pain. Physical therapy may also be utilized to improve function and reduce pain by increasing foot and ankle strength and enhancing range of motion. Studies show that physical therapy improves outcomes in such cases (Kulig et al., 2009; Bowring and Chockalingam, 2009). Participation in resistive exercises particularly can enhance strength of the muscles around the ankle and increase support provided by the muscles to the posterior tibial tendon, thereby facilitating function and mobility of the foot (Durrant et al., 2011).

In cases in which pain and disability do not improve with pain management and physical training, surgical intervention may be required to repair, reestablish or even recreate the damaged tendon (Arnoldner et al., 2015). Important for a swift and complete recovery from surgery is rehabilitation to muscles and gait (Albano et al., 2018). Most patients are able to substantially improve their mobility and quality of life after surgery.

PTTD not only affects the physical abilities to walk or run but also renders tasks of daily living, leisure activities or exercises challenging for the patients. The resulting decline in physical fitness may render the patient depressed and frustrated at times. The condition has serious consequences for the general health and happiness of patients and thus early diagnosis is fundamental. Treating symptoms of PTTD causes can indeed help the patient in preventing further complications. For this reason, emphasis is laid on treating the condition early to help patients lead better lives and prevent decline in physical fitness while maintaining good mental health (Lohrer and Nauck, 2010). Patients will be able to participate in activities such as walking, running and performing exercises to improve their overall health, thus enhancing their quality of life (Rehman et al., 2024).

Citations:

Ling, S.K.K. and Lui, T.H., 2017. Posterior tibial tendon dysfunction: an overview. The open orthopaedics journal, 11, p.714. https://pmc.ncbi.nlm.nih.gov/articles/PMC5620404/

Durrant, B., Chockalingam, N. and Hashmi, F., 2011. Posterior tibial tendon dysfunction: a review. Journal of the American Podiatric Medical Association, 101(2), pp.176-186. https://japmaonline.org/view/journals/apms/101/2/1010176.xml

http://www.europeanreview.org/wp/wp-content/uploads/13-19-Anatomy-pathophysiology-and-classification-of-posterior-tibial-tendon-dysfunction.pdf

Kulig, K., Reischl, S.F., Pomrantz, A.B., Burnfield, J.M., Mais-Requejo, S., Thordarson, D.B. and Smith, R.W., 2009. Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise: a randomized controlled trial. Physical Therapy, 89(1), pp.26-37. https://academic.oup.com/ptj/article-abstract/89/1/26/2737558

Bowring, B. and Chockalingam, N., 2009. A clinical guideline for the conservative management of tibialis posterior tendon dysfunction. The Foot, 19(4), pp.211-217. https://www.sciencedirect.com/science/article/pii/S0958259209000753

Rehman, M., Duarte Silva, F. and Chhabra, A., 2024. Diagnostic efficacy of posterior tibialis tendon dysfunction: a systematic review of literature. European Radiology, 34(5), pp.3513-3523. https://link.springer.com/article/10.1007/s00330-023-10364-1

Gluck, G.S., Heckman, D.S. and Parekh, S.G., 2010. Tendon disorders of the foot and ankle, part 3: the posterior tibial tendon. The American journal of sports medicine, 38(10), pp.2133-2144. https://journals.sagepub.com/doi/abs/10.1177/0363546509359492

Albano, D., Martinelli, N., Bianchi, A., Romeo, G., Bulfamante, G., Galia, M. and Sconfienza, L.M., 2018. Posterior tibial tendon dysfunction: Clinical and magnetic resonance imaging findings having histology as reference standard. European Journal of Radiology, 99, pp.55-61. https://www.sciencedirect.com/science/article/pii/S0720048X17305193

Lohrer, H. and Nauck, T., 2010. Posterior tibial tendon dislocation: a systematic review of the literature and presentation of a case. British journal of sports medicine, 44(6), pp.398-406. https://bjsm.bmj.com/content/44/6/398.short

Arnoldner, M.A., Gruber, M., Syré, S., Kristen, K.H., Trnka, H.J., Kainberger, F. and Bodner, G., 2015. Imaging of posterior tibial tendon dysfunction—Comparison of high-resolution ultrasound and 3 T MRI. European Journal of Radiology, 84(9), pp.1777-1781. https://www.sciencedirect.com/science/article/pii/S0720048X15002685