Posterior Tibial Tendon Dysfunction
Posterior Tibial Tendon Dysfunction
is a common problem amongst hard working people. This is a classic over use injury and
affects a particular tendon in the foot, the posterior tibial tendon. This tendon helps to
hold the arch of the foot and prevents your feet from rolling in too much. The patients in
step of the foot may appear inflamed and may have a pronounced flat foot deformity.
Symptoms include pain at the in step
of the foot, especially along the course of the tendon. There may be burning, tingling,
shooting or stabbing pain present in the foot. This is due to the inflammation of the
nerve that surrounds the tendon. If a patient is asked to stand on their toes, intense
pain will be present in the arch of the foot.
What causes Posterior Tibial Tendon Dysfunction
- Posterior Tibial Tendon Dysfunctionof
the posterior tibial tendon can be caused due to initial strain, minor degeneration and a
rupture of the tendon. The inflammation of the tendon is a secondary reaction.
- Initially, there is irritation of the
outer covering of the tendon. This is called paratendonitis. This leads to degeneration of
the tendon, which causes the tendon to become thicker. The tendon then becomes weaker and
loses its strength; this can lead to a complete rupture of the tendon.
- Flat foot types are at risk
- Tight heel cords (Achilles Tendon)
can lead to tendonitis of the foot.
- Walking or running up hill, i.e. golf
courses or marathon running can be the catalyst for tendonitis in the foot.
Diagnosis of Posterior Tibial Tendon Dysfunction
The diagnosis is based on both a history and a physical examination. Your physician may
ask you to stand on your bare feet facing away from him/her to view how your foot
functions. As the condition progresses, the front of the affected foot will start to slide
to the outside. From behind, it will look as though you have "too many toes"
showing. You may also be asked to stand on your toes or to do a single heel rise: stand
with your hands on the wall, lift the unaffected foot off the ground, and raise up on the
toes of the other foot. Normally, the heel will rotate inward; the absence of this sign
indicates posterior tibial tendon dysfunction. Your doctor may request X-rays, an
ultrasound or a magnetic resonance image (MRI) of the foot.
Treatment of Posterior Tibial Tendon Dysfunction
- Anti-inflammatory medication
- Cease all sporting activities
and try and stay off your feet as much as possible.
- Orthosis (insoles) may be necessary.
This will help to support the arch region of the foot. In our experience, this is the most
effective form of treatment.
- In severe cases surgery may be
necessary to repair the tendon.
Without treatment, the flatfoot that develops from posterior tibial tendon dysfunction
eventually becomes rigid. Arthritis develops in the hindfoot. Pain increases and spreads
to the outer side of the ankle. The way you walk may be affected and wearing shoes may be
The treatment your doctor recommends will depend on how far the condition has
progressed. In the early stages, posterior tibial tendon dysfunction can be treated with
rest, nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen, and
immobilization of the foot for 6 to 8 weeks with a rigid below-knee cast or boot to
prevent overuse. After the cast is removed, shoe inserts such as a heel wedge or arch
support may be helpful. If the condition is advanced, your doctor may recommend that you
use a custom-made ankle-foot orthosis or support.
If conservative treatments dont work, your doctor may recommend surgery. Several
procedures can be used to treat posterior tibial tendon dysfunction; often more than one
procedure is performed at the same time. Your doctor will recommend a specific course of
treatment based on your individual case. Surgical options include:
- Tenosynovectomy. In this procedure, the surgeon will clean away (debride) and remove
(excise) any inflamed tissue surrounding the tendon.
- Osteotomy: This procedure changes the alignment of the heel bone (calcaneus). The
surgeon may sometimes have to remove a portion of the bone.
- Tendon transfer: This procedure uses some fibers from another tendon (the flexor
digitorum longus, which helps bend the toes) to repair the damaged posterior tibial
- Lateral column lengthening: In this procedure, the surgeon removes a small wedge-shaped
piece of bone from the hip and places it into the outside of the calcaneus. This helps
realign the bones and recreates the arch.
- Arthrodesis: This procedure welds (fuses) one or more bones together, eliminating
movement in the joint. This stabilizes the hindfoot and prevents the condition from