Posterior tibial tendon dysfunction(PTTD), also known as posterior tibial tendonitis, is one of common conditions of the ankles and feet. PTTD is caused by inflammation or tearing of the posterior tibial tendon, which is one of the major supporting structures of the foot. As a result, the tendon is not able to support the arch of the foot. This causes flatfoot – the foot is fallen and the foot points outwards.
Causes
An acute injury can cause the posterior tibial tendon to be inflamed or tear. Overuse of the tendon can also cause tear. Common activities that cause an overuse injury include:
– walking – running -climbing stairs -Playing basketball, soccer and tennis
PTTD is more likely to occur in females and people over 40 years old. Additionally, it is more common in people with obesity, diabetes, and hypertension.
Symptoms
Many people may have had a recent ankle sprain, although some may had no injury. PTTD usually occurs in one foot but some people can develop it in both feet.
The symptoms may include :
– Pain from the lower leg to the inside of the foot and ankle. Pain is worse during activity, such as running, Some people can have difficulty standing or walking for a period of time.
– Swelling and warmth on the course of the tendon
– As PTTD progresses, the arch of the foot can flatten, the toes begin to point outwards and the ankle will roll inward. This is the result of the posterior tibial tendon not being able to support the arch of the foot.
– The location of the pain can change to the outside of the foot, below the ankle. This is because the heel bone may shift outwards and put pressure on the outside ankle bone.
– In some cases, arthritis may develop in the foot and ankle.
Treatments
resting
The initial advice is normally focused on resting to allow to the tendon to heal. Switch from high-impact activities such as running, soccer and basketball to biking and swimming.
Foot support
some forms of support for the foot and ankle may be suggested:
– Orthotics help support the foot and restore the normal arch of the foot position.
– An ankle brace help take tension off the tendon and allow it to heal quickly.
– A short leg cast or walking boot may be used to prevent motion so can allow the tendon to rest. However, this causes weakening of the leg muscles or atrophy.
Anti-inflammatory Drugs
Medication, such as ibuprofen can reduce inflammation and pain.
Physical Therapy
Physical therapy can help to strengthen the tendon to alleviate the pain.
Steroid Injection
If the above treatments do not provide relief, cortisone injection may be considered. Because cortisone is a very powerful anti-inflammatory medicine, the injection carries a risk of tendon rupture.
Acupuncture
If all of the treatments above do not provide relief; if you are tired with the braces, cast or walking boots; if you want to avoid taking anti-inflammatory medication or cortisone injection; if you want to try alternative therapy before the last option-surgery; if you are considering a natural approach, please call Floreat Acupuncture on 08 6113 6208 for an appointment. Approximately 80% of our clients suffering from foot pain improved straight after the first session, but please keep in mind that it may take 3-5 sessions to allow your foot to get the best possible result.
Surgery
Surgery may be considered if the PTTD is severe and the treatments haven’t been successful. Surgical Options depend on the location of the tendonitis and how much the tendon is damaged. However, some people will notice limit of ROM after surgery and additional procedures may also be required later on.
