Posterior Tibial Tendon Dysfunction - Causes, Features, and Management

Introduction:

The posterior tibial tendon is a vital structure. It runs from the calf muscle to the inside of the ankle and foot. This tendon helps maintain the foot arch and supports the foot when walking. However, sometimes, for various reasons, the posterior tibial tendon may weaken or become damaged, resulting in posterior tibial tendon dysfunction (PTTD).

PTTD is most commonly seen in individuals who are over 40 years of age and those who are overweight

What Are the Causes of Posterior Tibial Tendon Dysfunction?

Some of the other factors that may contribute to the development of PTTD include:

• Overuse: The posterior tibial tendon can become damaged due to overuse, especially in people who participate in activities that put a lot of strain on the feet, such as running or jumping.

• Trauma: The tendon can also become damaged due to a direct injury to the ankle, such as a sprain or fracture.

• Age-Related Degeneration: Our tissues, including the posterior tibial tendon, can become weaker and more prone to damage.

• Other Medical Conditions: Various medical conditions, such as rheumatoid arthritis, can cause inflammation and weaken the posterior tibial tendon, leading to PTTD.

What Are the Signs and Symptoms of Posterior Tibial Tendon Dysfunction?

The symptoms of PTTD include the following:

• Pain and Swelling - Pain and swelling on the inside of the ankle and foot are common symptoms of PTTD. The pain may be mild initially and worsen over time as the condition progresses. The swelling may be mild to severe and may be accompanied by redness or warmth in the affected area.

• Flatfoot Deformity - A flatfoot deformity is a common symptom of PTTD. The foot arch collapses, and the foot appears flat when standing.

• Difficulty Walking or Standing - People with PTTD experience difficulty in walking for long periods. This is because the posterior tibial tendon helps support the foot arch and provides stability when walking. When the tendon is damaged, maintaining balance and walking or standing comfortably can be challenging.

• Overpronation - Overpronation is an inward rolling of the ankle that can occur due to PTTD. It causes extra stress on the foot, ankle, and leg, which can cause pain and discomfort.

• Weakness - PTTD can cause weakness in the ankle and foot, making it challenging to move the affected area. This can also lead to a decreased range of motion and stiffness in the foot and ankle.

• Aching or Fatigue - People with PTTD may experience aching or fatigue in the leg, ankle, or foot. This can be caused by the increased stress on the foot and ankle due to the flatfoot deformity and overpronation.

• Tenderness - Tenderness when touching the affected area is also a common symptom of PTTD. The area around the posterior tibial tendon may be tender to the touch, and pressure can exacerbate the pain and discomfort.

• Stiffness - Stiffness in the foot or ankle is another symptom of PTTD.

• Reduced Range of Motion - PTTD can also cause a reduced range of motion in the affected foot or ankle. This makes it difficult to perform everyday activities and can lead to additional discomfort.

• Swelling or Warmth - Swelling or warmth around the affected area is another symptom of PTTD. This can be caused by inflammation and can exacerbate the pain and discomfort.

• Bump or Prominence - In some cases, a bump or prominence may develop inside the foot or ankle. This can result from the flatfoot deformity and cause additional pain and discomfort.

How to Diagnose Posterior Tibial Tendon Dysfunction?

PTTD can be diagnosed by:

• Physical Exam - A physical exam is often the first step in diagnosing PTTD. The doctor used to examine the foot and ankle for swelling, signs of tenderness, and range of motion.

• Imaging Tests - Imaging tests, including X-rays, ultrasound, or MRI (magnetic resonance imaging), used to evaluate the foot and ankle further. X-rays can show changes in the bone structure of the foot and ankle, while ultrasound and

• Gait Analysis - Gait analysis is a specialized test that evaluates how a person walks or runs.

• Electromyography (EMG) - A diagnostic test that measures the electrical activity present in the leg muscles and leg nerves in the affected area. This test can help determine if there is any nerve damage or muscle weakness contributing to the PTTD.

• Differential Diagnosis - The doctor may also consider other conditions that may have similar symptoms to PTTD, such as tarsal tunnel syndrome, ankle arthritis, or a stress fracture. A differential diagnosis can ensure that the correct diagnosis is made and the appropriate treatment is prescribed.

What Is the Treatment of Posterior Tibial Tendon Dysfunction?

PTTD can be treated by:

• Rest and Immobilization - Resting the affected foot and immobilizing it with a cast or brace can help reduce inflammation and pain. This can also prevent further damage to the posterior tibial tendon.

• Physical Therapy - Physical therapy strengthen the muscles and shows improvement in the range of motion in the foot and ankle. This can also help improve stability and reduce overpronation.

• Orthotics - These custom-made shoe inserts can help support the foot arch and reduce overpronation. They can also help redistribute pressure on the foot and ankle, reducing pain and discomfort.

• Medications - Nonsteroidal anti-inflammatory drugs (NSAIDs), including Ibuprofen or Naproxen, reduces pain and inflammation. Sometimes, corticosteroid injections may be used to provide relief from pain and inflammation.

• Surgery - Surgery is necessary in severe cases. It may involve repairing or replacing the damaged tendon, fusing the bones in the affected area, or realigning the bones in the foot and ankle.

• Lifestyle Changes - These include losing weight, wearing appropriate footwear, and avoiding activities that exacerbate the condition can also help reduce symptoms and prevent further damage to the posterior tibial tendon.

Conclusion:

Posterior tibial tendon dysfunction affects the posterior tibial tendon, which supports the foot arch. It occurs by overuse or injury, leading to pain, swelling, and arch flattening. Accurate and early diagnosis and proper treatment are crucial to prevent further damage and complications. Treatment options include rest, physical therapy, orthotics, medications, surgery, and lifestyle changes. It is a must to consult a doctor if any symptoms of PTTD are experienced to prevent the condition from progressing. Following the appropriate treatment plan, patients can improve their symptoms and maintain a healthy lifestyle.