Posterior Tibial Tendon Dysfunction (PTTD)

Definition

Posterior Tibial Tendon Dysfunction (PTTD) is one of the most common tendon disorders of the ankle.  It is usually caused by chronic inflammation of the tendon, degenerative changes, and occasionally trauma, which leads to stretching, laxity, and eventual rupture of the posterior tibial tendon.  

Anatomy

The posterior tibial tendon runs along the inside (medial side) of the ankle.  It helps to support the arch of the foot, and provides power to point the toes down and to turn the foot inward.  

Symptoms

Patients often experience tenderness and inflammation along the inner part of the ankle.  They note weakness when standing on their toes.

As the problem progresses, patients describe loss of the arch of the foot while standing.  Patients often note continued pain and inflammation.  The foot tends to turn outward with weight bearing.  Late stage disease includes a flat foot deformity with degenerative changes in the joints below the ankle.

Treatment

Initial treatment includes anti-inflammatory medications, rest, and ice.  Shoe inserts and wedges often provide relief of symptoms.  Occasionally, ankle-foot braces or casts are used.  If nonsurgical measures fail, then surgery may be considered.  Operative repair may include reconstruction of the tendon, osteotomies (bone cuts), and/or fusion of different joints of the foot.