Posterior Tibial Tendon Dysfunction (PTTD)
This is usually reported as a pain in the medial arch area of the foot or towards the inside ankle bone (medial malleolus).
There will be difficulty or pain on trying to stand on the toes/raise the heel off the floor.
The causes of this condition are multifactorial but in about 50% of cases it arises from an injury. Contributing factors include age, obesity, high blood pressure and Rheumatoid arthritis. Overuse can also be a factor in chronic PTTD.
This particular tendon is used to invert and plantarflex the foot at the ankle as well as maintaining the medial arch. It decelerates the internal rotation of the tibia in order to limit the pronation of the foot following heel strike.
PTTD is a symptomatic progressive deformity which occurs when inflammation or tearing happens in the tendon. As a result, the tendon may not be able to provide the stability and support of the foot which results in a flat footed appearance (pes planus). PTTD commonly presents uni-laterally.
PTTD is a prevalent cause of pathological deformity of pes planus in adults such that if left untreated may result in significant functional impairment and has damaging effects of life for an individual. Early conservative treatment improves the quality of life for an individual regarding pain, function and disability and also decreases the need for surgical intervention.
Where the muscle meets the tendon (musculotendinous junction) passes posterior to the medial malleolus distally forming a distinctive gliding zone that has a fibrocartilaginous element which assists in prevention of friction, pressure and wear of the tendon. The existence of the fibrocartilage is an area for possible degenerative changes and may clarify why it is susceptible to pathological ruptures.
Stage I: Posterior tibial tendon intact and inflamed, no deformity, mild swelling.
Stage II: Posterior tibial tendon dysfunctional, acquired pes planus but passively correctable, commonly unable to perform a heel raise
Stage III: Degenerative changes in the subtalar joint and the deformity is fixed.
Stage IV ( Myerson): Valgus tilt of talus leading to lateral tibiotalar degeneration
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