Posterior Tibial Tendonitis

Posterior Tibial Tendon
The posterior tibial tendon extends from a muscle deep in the back of the leg, along the inside of the ankle, and attaches to the inside and bottom of the arch. This tendon is the single most important tendon to support the arch. Contraction of the posterior tibial muscle in the back of the leg causes the tendon to pull on the foot bones, helping to lift the heel from the ground, and inverting the foot (rolling the ankle to the outside). Consequently, failure of this tendon work properly causes the foot to roll inwards and the arch to drop. Because PTTD is generally a condition seen in adults and the dysfunction leads to a flattening of the arch, the term adult acquired flatfoot is often used in conjunction with posterior tibial tendon dysfunction.

Posterior Tibial Tendon Dysfunction
The term posterior tibial tendon dysfunction (PTTD) describes the tendon’s inability to perform its task of supporting the foot. This tendon is susceptible to dysfunction if it is overworked or overused. This dysfunction begins as tendonitis, or inflammation around the tendon. This inflammation can cause the tendon to swell, hurt, and eventually it can lead to damage of the tendon. As PTTD worsens, other foot problems may begin to appear such as: pain in other parts of the foot or leg or arthritis because of the excess strain on joints normally supported by the tendon.

Causes of PTTD
Posterior tibial tendon dysfunction is an overuse injury associated with increases or changes in activity, faulty biomechanics (the movement of the foot, ankle, and leg), compensation for another injury or problem, and even improper shoes. In some instances, the tendon can be acutely injured such as with a sprain or strain of the ankle, arch, or foot.

Risk Factors

  • Obesity
  • Hypertension
  • Diabetes
  • Female gender
  • Previous trauma or injury
  • Steroid injections into the tendon
  • Inflammatory or auto-immune diseases

Symptoms of PTTD
The symptoms of PTTD include pain, swelling along the inside of the ankle and arch, warmth along the same course, flattening of the arch, inward rolling of the heel and ankle.

Conservative Treatment
The primary treatment goal with PTTD is to reduce inflammation. This is important not just because the inflammation is painful, but also because it can lead to tendon damage if present for too long. The tendon must be supported and protected during the healing process. This involves proper shoes, and orthotics or bracing. Finally, those risk factors that may have led to the tendon dysfunction must be addressed and managed.

Surgical treatment
The goal of surgical treatment is to restore proper alignment to the foot bones and repair any damage that may be present in the tendon. Surgical options are typically needed once conservative treatment has failed or when more the tendon dysfunction has advanced to involve tendon damage, arthritis, or when the foot has become more rigid in its position. The choice of surgical procedures to correct a dysfunctional posterior tibial tendon can vary from simple debridement and repair of the tendon, to osteotomies (cutting and realignment of a bone), or fusion of painful joints. Each surgical case is unique and appropriate attention must be paid to each patient’s circumstances.

This information is not intended to diagnose, treat, or prevent any injury or disease. It is intended to serve as an overview of running-related injuries and should not be used as a substitute for sound medical advice from a doctor or therapist.