Posterior tibial tendon dysfunction (PTTD)
Understanding Posterior tibial tendon dysfunction
By Neurosurgery Singapore
What is define by Posterior tibial tendon dysfunction (PTTD)?
The posterior tibial tendon is an important tendon in the leg. A tendon (strong cord-like tissue) attaches muscles to bones. The posterior tibial tendon attaches the calf muscle to the bones in the foot. The posterior tibial tendon extends from the calf down to the inside of the ankle and the bones of the foot. It is important for walking as it supports the stability and arch of the foot.
Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot. It is different from foot drop. PTTD is usually progressive, which means it will keep getting worse, especially if it is not treated early.
What are some symptoms of Posterior tibial tendon dysfunction (PTTD)?
Most commonly, people with posterior tibial tendonitis:
- Swelling in the ankle
- Weakness in the foot
- Pain on the inside of the foot and ankle bone (medial malleolus)
- Spasms of the peroneal tendons on the outside of the foot
- A gradual flattening of the arch of the foot (a flat foot)
- Pain in the tarsal tunnel (similar to carpal tunnel in the hand)
- Difficulty walking or running
Many people with this condition report having had a recent ankle sprain. However, some will have had no recent injury. The tendon can also be damaged from overuse.
“Posterior tibial tendonitis is a common cause of foot pain and dysfunction. When caught early, posterior tibial tendonitis is fairly easy to treat. But, without proper diagnosis and treatment, it gradually progresses through four different stages, which can result in permanent foot deformity.”
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What types of diagnosis?
We highly recommend seeking professional help instead of self diagnosis in order to identify the source of the issue and to receive faster recovery.
During a physical, our Specialist who specializes in foot and ankle problems, can diagnose posterior tibial tendonitis by physical examination. People with the condition have:
- Tenderness and swelling along the posterior tibial tendon
- Weakness when trying to point their toes inward
- Trouble standing on their toes on the affected side
If the examination is unclear or our doctor is considering surgical repair, they may order a MRI scan. The MRI can determine whether the tendon has ruptured, and where. It can also show inflammation surrounding the tendon.
Posterior tibial tendonitis is classified according to the stage of the condition. Stage 1 through stage 4 indicate increasing deformity (abnormal shape) of the foot as the condition progresses:
- Stage 1: The earliest stage is having pain and swelling along the tendon. The foot may appear completely normal. On the other hand, some people may notice their foot has a mild flatfoot deformity. This may be something they feel they have always had.
- Stage 2: As the condition progresses, the arch of the foot begins to collapse. When they stand, the foot appears flat along its inner side. At this stage, it may be possible to correct the flattened arch.
- Stage 3: In stage 3 of the condition, called a rigid flatfoot deformity, a physician cannot easily correct the foot.
- Stage 4: In stage 4, not only is the foot involved, but the adjacent ankle joint also is affected by the condition.
Possible treatment methods?
Treatment for an ACL tear will vary depending upon the patient’s individual needs. For example, the young athlete involved in agility sports will most likely require surgery to safely return to sports. However the less active individual may be able to return to a quieter lifestyle without surgery.
Nonsurgical Treatment
A torn ACL will not heal without surgery. But nonsurgical treatment may be effective for patients who are elderly or have a very low activity level. If the overall stability of the knee is intact, our doctor may recommend simple, nonsurgical options.
Bracing. Our Specialist may recommend a brace to protect your knee from instability. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.
Physical therapy. As the swelling goes down, a careful rehabilitation program is started. Therefore specific exercises will restore function to your knee and strengthen the leg muscles that support it.
Surgical Treatment
Rebuilding the ligament. Most ACL tears cannot be sutured (stitched) back together. To surgically repair the ACL and restore knee stability, the ligament must be reconstructed. Our Orthopaedic Surgeon will replace your torn ligament with a tissue graft. This graft acts as a scaffolding for a new ligament to grow on.
Grafts can be obtained from several sources. Often they are taken from the patellar tendon, which runs between the kneecap and the shinbone. Hamstring tendons at the back of the thigh are a common source of grafts. Sometimes a quadriceps tendon, which runs from the kneecap into the thigh, is used. Finally, cadaver graft (allograft) can be used.
The regrowth takes time, it may be six months or more before an athlete can return to sports.
Procedure. Surgery to rebuild an anterior cruciate ligament is done with an arthroscope using small incisions. Arthroscopic surgery is less invasive. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker recovery times.
Our team has the expertise and treatment to speedy recovery.
