What are the other Names for this Condition? (Also known as/Synonyms)

• Posterior Tibial Tendon Insufficiency (PTTI)
• PTTD (Posterior Tibial Tendon Dysfunction)
• PTTI (Posterior Tibial Tendon Insufficiency) 

What is Posterior Tibial Tendon Dysfunction? (Definition/Background Information)

• Posterior Tibial Tendon Dysfunction (PTTD) is a common condition that results when the posterior tibial tendon (present in the foot and ankle) is torn or inflamed
• This condition may often result in flatfoot due to the tendon’s inability to provide any strength and support to the arch of the foot
• For a majority of the individuals with Posterior Tibial Tendon Dysfunction, the treatment methods include the use of specialized orthotics and braces. However, if these nonsurgical methods do not relieve the pain, surgery may be beneficial in treating the foot pain
• The prognosis of individuals with Posterior Tibial Tendon Dysfunction is usually good, when properly treated. 

Who gets Posterior Tibial Tendon Dysfunction? (Age and Sex Distribution)

• Generally, women over the age of 40 years have the highest risk of developing symptoms of Posterior Tibial Tendon Dysfunction
• Females are more likely to develop the condition than males
• No ethnic or racial preference is seen 

What are the Risk Factors for Posterior Tibial Tendon Dysfunction? (Predisposing Factors)

Risk Factors of Posterior Tibial Tendon Dysfunction include:

• Advancing age
• Abnormal pressure on the foot or ankle, due to excessive body weight, such as obesity
• Women have a higher incidence of the condition than men
• Any traumatic injury or overuse of the posterior tibial tendon
• An inflammatory disorder such as rheumatoid arthritis
• Psoriasis
• Diabetes
• High blood pressure (hypertension)
• Steroid use (such as performance-enhancing steroids)
• Reiter’s syndrome
• Spondylosing arthropathy

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Posterior Tibial Tendon Dysfunction? (Etiology)

Common causes of Posterior Tibial Tendon Dysfunction include:

• An injury or overuse of the posterior tibial tendon is the most common cause of Posterior Tibial Tendon Dysfunction. This usually occurs in individuals who participate in high-impact sports, such as basketball, tennis, soccer, or running
• An inflammatory or autoimmune disorder, such as rheumatoid arthritis, which not only damages the cartilage within the joints, but also the ligaments that support the foot
• Individuals with diabetes or nerve damage, which may reduce sensation within the feet, causing a collapse of the arch

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

Signs and symptoms of Posterior Tibial Tendon Dysfunction include:

• Pain on the inside of the foot and ankle
• Pain in the heel or arch of the foot
• Difficulty participating in high-impact sports such as running, due to pain
• Difficulty standing or walking
• Noticeable swelling on the inside of the ankle 

How is Posterior Tibial Tendon Dysfunction Diagnosed?

Posterior Tibial Tendon Dysfunction is diagnosed using the following tools:

• Physical examination: During a thorough physical examination for Posterior Tibial Tendon Dysfunction, a physician will examine the individual while walking and test the range of motion of the foot and ankle joints. In addition to this, a complete medical history can aid in arriving at a definitive diagnosis
• X-ray of the foot: A physician may order an x-ray to help detect the presence of arthritis
• Magnetic resonance imaging (MRI) of the foot: An MRI is a more detailed scan that uses a magnetic field to generate thorough images of the interior bones and soft tissues, which helps confirm a diagnosis
• Computerized tomography (CT) scan of the foot: A CT scan takes a series of x-ray images from several different angles. These images are then merged to create cross-sectional images of bones and soft tissues of the foot. The CT scan images can then allow the physician to examine the foot and surrounding structures to confirm a diagnosis
• General ultrasound imaging of the foot: If the physician believes that there may be a damaged tendon, an ultrasound of the foot may be ordered. Ultrasounds are high-frequency sound waves that generate a detailed image of the tendons in the body 

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Posterior Tibial Tendon Dysfunction? 

Persistent pain is the most common complication of Posterior Tibial Tendon Dysfunction. However, some complications that may arise after surgical treatments include: 

• Fused bones that do not heal
• Permanent deformity of the foot resulting from flatfoot
• Foot infection
• Decreased range of motion of the ankle 

How is Posterior Tibial Tendon Dysfunction Treated?

Both nonsurgical and surgical methods may be used to treat Posterior Tibial Tendon Dysfunction. However, if the condition is treated early, the symptoms may be resolved without any surgical techniques. 

Nonsurgical treatments for Posterior Tibial Tendon Dysfunction include: 

• Oral medications, such as ibuprofen and naproxen, can help decrease pain and swelling in the foot
• If an individual is experiencing pain in the foot, ankle, or leg caused by any physical activity, the physician may recommend exercises to stretch the heel cord
• A well-padded custom-made shoe insert may be used to relieve pain
• Complete immobilization of the foot with a cast may be required to restrict movement
• If prolonged immobilization of the foot occurs, a physician may recommend ultrasound therapy or physical therapy exercises 

If conservative methods are not successful in controlling the symptoms, the physician may recommend a surgery. 

Surgical treatments for Posterior Tibial Tendon Dysfunction include: 

• Gastrocnemius recession: Gastrocnemius recession is the surgical lengthening of the calf (gastrocnemius) muscles. Tight calf muscles put a great deal of stress on the Achilles's tendon. This surgical procedure helps individuals, who have a limited range of motion with the heel
• Arthrodesis of the foot: Arthrodesis is a surgical procedure that involves fusing together one or more joints within the back of the foot. The procedure helps in realigning the foot, removing any arthritis, and preventing the condition from deteriorating further
• Tenosynovectomy: Tenosynovectomy is a surgical procedure that involves removing the damaged tissue that surrounds the tendon. This may be a stand-alone procedure or can be performed along with other surgical techniques
• Tendon transfer: A tendon transfer is a procedure that uses another tendon from a different part of the body to repair the injured posterior tibial tendon. This procedure is designed to restore mobility of the foot and ankle that has lost its functionality
• Calcaneal osteotomy: Calcaneal osteotomy is an open reduction procedure that involves a controlled surgical break of the calcaneus (heel bone). This procedure is performed to correct a deformity of the foot and ankle 

How can Posterior Tibial Tendon Dysfunction be Prevented?

Currently, there are no specific methods or guidelines to prevent Posterior Tibial Tendon Dysfunction. However, there are certain measures that may help in preventing abnormal pressure on the foot or ankle joint:

• Maintaining a healthy body weight can help prevent abnormal pressure on the foot or ankle joints
• Individual are advised to take appropriate measures to prevent an injury or trauma to the posterior tibial tendon
• Active research is currently being performed to identify tissue abnormalities and potential causes responsible for Posterior Tibial Tendon Dysfunction. This has the possibility to lead to improved treatment methods and preventative techniques

What is the Prognosis of Posterior Tibial Tendon Dysfunction? (Outcomes/Resolutions)

• The majority of cases involving Posterior Tibial Tendon Dysfunction are painless, and complications are rare.
• Some individuals with this condition may experience pain that can be treated with nonsurgical methods
• If conservative methods are unsuccessful in treating the foot condition, then surgery may be required to relieve the pain in the foot 

Additional and Relevant Useful Information for Posterior Tibial Tendon Dysfunction:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/podiatry-lower-leg-center/