Treatments Classes

Flat Feet- Posterior Tibial Dysfunction

What is Posterior Tibial Tendon Dysfunction

Posterior tibial tendon dysfunction (PTTD) has been shown to be one of the most common cause of adult acquired flat foot[1], [2] or over pronation.
It involves the progressive flattening of the arch due to damage or overuse of the Posterior tibial tendon. In the early stages of the pathology conservative treatments such as insoles and exercises are regularly employed. It has been shown that conservative treatment can significantly improve the quality of life, function and reduce pain [3], [4].
The exact cause of PTTD is unknown (4) and it is believed to be multifactorial with overuse being the underlying cause.

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Symptoms

Pain in the arch and ankle
Noticeable flattening of the arch as the condition progresses
Lateral (outside) ankle pain in later stages

Treatments

In its early stages offloading of the inflamed tendon is recommendation and standard RICE protocols are suggested. The use of Orthotic insoles is recommended in the early stages alongside Physiotherapy to achieve optimal outcomes[5].
As the condition progresses more aggressive and rigid insoles or ankle braces are recommended along with the use of supportive trainers.
Surgery is often required if the condition progresses past the point where orthotics and physiotherapy is of benefit and permanent structural damage has occurred to both soft tissue and bone[6].

References

[1] D. A. Funk, J. R. Cass, and K. A. Johnson, “Acquired adult flat foot secondary to posterior tibial-tendon pathology Posterior,” J. Bone Jt. Surg., vol. 68, pp. 95–102, 2008.
[2] T. C. Beals, G. C. Pomeroy, and A. Manoli, “Posterior tibial tendon insufficiency: diagnosis and treatment.,” J. Am. Acad. Orthop. Surg., vol. 7, no. 2, pp. 112–8, 1999.
[3] B. Durrant, N. Chockalingam, and F. Hashmi, “Posterior tibial tendon dysfunction: A review.,” J. Am. Podiatr. Med. Assoc., vol. 101, no. 2, pp. 176–86, 2011.
[4] J. T. Deland, “Adult-aquired Flatfoot Deformity,” J Am Acad Orthop Surg, vol. 16, no. 7, pp. 399–406, 2008.
[5] R. G. Alvarez, A. Marini, C. Schmitt, and C. L. Saltzman, “Stage I and II posterior tibial tendon dysfunction treated by a structured nonoperative management protocol: an orthosis and exercise program.,” Foot ankle Int., vol. 27, no. 1, pp. 2–8, Jan. 2006.
[6] G. a Arangio, V. Chopra, A. Voloshin, and E. P. Salathe, “A biomechanical analysis of the effect of lateral column lengthening calcaneal osteotomy on the flat foot.,” Clin. Biomech., vol. 22, no. 4, pp. 472–7, May 2007, doi: 10.1016/j.clinbiomech.2006.11.004.

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