Posterior Tibial Tendon Dysfunction (PTTD)

Posterior Tibial Tendon Dysfunction (PTTD) is an alteration of the function of the posterior tibial tendon. This may be due to a rupture, laceration, inflammation, abnormal insertion, or attenuation of the tendon. With dysfunction of the tendon there can be excessive pronation of the foot and an acquired flatfoot.

Symptoms of a posterior tibial tendon dysfunction is usually pain with walking/standing as well as a noticeable flatting of the foot while walking/standing. There maybe increased shoe irritation in the arch of the foot as the foot is allowed to excessively pronate or roll inward.

Prevention is aimed at treating the cause of the PTTD to prevent associated conditions of having a flatfoot. The best prevention may be to get advice from your podiatrist.

Podiatric Care usually begins with x-rays to evaluate the structure of your foot and determine the cause of the deformity. If tendon pathology is suspected but unclear your physician may order an additional test using an MRI. The MRI will help determine if there was a complete or partial rupture, attenuation or swelling around the posterior tibial tendon. Conservatively, they may advise you on different shoewear or prescribe a custom made orthotic to try and control the foot structure especially if you have excessive pronation. Additional support of the foot and ankle can be performed with strapping or a brace. Treatment may also include using anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce swelling. Your podiatric physician may also recommend a surgical procedure to actually fix the structural problem of your foot.

Surgery to correct PTTD is varied. If the tendon has pathology, such as a rupture, a direct repair may be indicated. Your podiatric surgeon may also augment this tendon with a tendon graft or tendon transfer. A chronic (old) condition of PTTD may produce bone deformity and breakdown leading to severe osteoarthritis at different joints. An arthrodesis may be suggested of the joint/joints in the foot or ankle for stability. Another procedure used for PTTD occasionally is an artheroesis procedure. Artheroesis means joint limiting and involves placing some type of implant or plug within the subtalar joint to stop excessive motion. Your podiatrist will give you advise on what procedure is best for you if indicated.

Post-operative Care and Risks of surgery is varied depending on age, weight, health status, and mostly what procedure was performed. You may need a cast to protect you for a short time. Sometimes a soft bandage with a post-operative shoe is allowed. You should expect some pain following surgery as well as swelling. Especially for the first 48 hours you should keep your leg elevated and an occasional ice pack placed over the area of surgery (about 20 minutes per hour). Surgical cuts are made through the skin so a scar is expected. If you are a keloid former, let your surgeon know. Surgical cuts are not only made through skin, but through other layers of tissue as well, a scar may form within your foot and lead to adhesions. For many bunion procedures you will be required to keep all weight off of your foot for several weeks, typically 5-8 weeks or more depending on procedure. You may use crutches, a walker, or wheelchair to help you keep weight off of this foot. Healing time is typically 6-8 weeks for all bone cuts if they are performed. This is influenced by many factors including your nutrition, circulation, and other medical conditions. If you are a smoker you can expect to take longer to heal. If you are required to keep pressure off of your foot your leg muscles are not being used as they were before surgery. This allows for slower movement of the blood through the leg vessels. Occasionally this can lead to a blood clot in the leg which can become life threatening. Hip and knee flexion and extension exercises as well as wiggling your toes gently can help prevent this from occurring. If you have a history of blood clots you should let your surgeon know.