There are four stages of posterior tibial tendon dysfunction
. In the first stage the
posterior tibial tendon is inflamed but has normal strength. There is little to no change in the arch of the foot. In stage two the tendon is partially torn or shows degenerative changes and as a
result loses strength. There is considerable flattening of the arch without arthritic changes in the foot. Stage three results when the posterior tibial tendon is torn and not functioning. As a
result the arch is completely collapsed with arthritic changes in the foot. Stage four is identical to stage three except that the ankle joint also becomes arthritic.
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing
Often, this condition is only present in one foot, but it can affect both. Adult acquired flatfoot symptoms vary, but can swelling of the foot's inner side and aching heel and arch pain. Some
patients experience no pain, but others may experience severe pain. Symptoms may increase during long periods of standing, resulting in fatigue. Symptoms may change over time as the condition
worsens. The pain may move to the foot's outer side, and some patients may develop arthritis in the ankle and foot.
Examination by your foot and ankle specialist can confirm the diagnosis for most patients. An ultrasound exam performed in the office setting can evaluate the status of the posterior tibial tendon,
the tendon which is primarily responsible for supporting the arch structure of the foot.
Non surgical Treatment
Flatfoot deformity can be treated conservatively or with surgical intervention depending on the severity of the condition. When people notice their arches flattening, they should immediately avoid
non-supportive shoes such as flip-flops, sandals or thin-soled tennis shoes. Theses shoes will only worsen the flatfoot deformity and exacerbate arch pain. Next, custom orthotics are essential for
people with collapsed arches. Over-the-counter insoles only provide cushion and padding to the arch, whereas custom orthotics are fabricated to specifically fit the patient?s foot and provide support
in the arch where the posterior tibial tendon is unable to anymore. Use of custom orthotics in the early phases of flatfoot or PTTD can prevent worsening of symptoms and prevent further attenuation
or injury to the posterior tibial tendon. In more severe cases of flatfoot deformity an ankle foot orthosis (AFO) such as a Ritchie brace is needed. This brace provides more support to the arch and
hindfoot rather than an orthotic but can be bulky in normal shoegear. Additional treatment along with use of custom orthotics is use of non-steroidal anti-inflammatories (NSAIDS) such as Advil,
Motrin, or Ibuprofen which can decrease inflammation to the posterior tibial tendon. If pain is severe, the patient may need to be placed in a below the knee air walker boot for several weeks which
will allow the tendon to rest and heal, especially if a posterior tibial tendon tear is noted on MRI.
For more chronic flatfoot pain, surgical intervention may be the best option. Barring other serious medical ailments, surgery is a good alternative for patients with a serious problem. There are two
surgical options depending on a person?s physical condition, age and lifestyle. The first type of surgery involves repair of the PTT by transferring of a nearby tendon to help re-establish an arch
and straighten out the foot. After this surgery, patients wear a non-weight bearing support boot for four to six weeks. The other surgery involves fusing of two or three bones in the hind foot below
the ankle. While providing significant pain relief, this option does take away some hind foot side-to-side motion. Following surgery, patients are in a cast for three months. Surgery is an effective
treatment to address adult-acquired flatfoot, but it can sometimes be avoided if foot issues are resolved early. That is why it is so important to seek help right away if you are feeling ankle pain.
But perhaps the best way to keep from becoming flatfooted is to avoid the risk factors altogether. This means keeping your blood pressure, weight and diabetes in check.