Posterior Tibial Tendon Dysfunction (PTTD)

What is Posterior Tibial Tendon Dysfunction?

So, it is a bit a mouthful, but what actually is Posterior Tibial Tendon Dysfunction (PTTD)? Basically, there is a muscle high up on the inside of your leg called the Posterior Tibial muscle. This muscle attaches to a tendon, tendons attach muscles to bone, and then it comes down the back of your leg and wraps around the inside of your ankle. It then inserts into a number of different bones in the middle of your arch.

When this becomes a problem, it can become sore around the middle of the ankle, or above and below this area. It is a reasonably common complaint.


I am often asked if feet get flatter with age. With PTTD, yes they do, and they can get flatter quite quickly. It is much more common in women than men, and usually occurs over the age of 40. It is not clear why, but we know that it is partly due to changes in, or lack of oestrogen. This hormone has a protective effect on tendons, the tendons are much more susceptible to strain and overload.

How Can I Manage This?

The key to managing this condition is to identify the problem early and to treat it with a good level of support, as well as trying to strengthen the tendon and muscle unit. The best way to tackle this is to have a thorough assessment, diagnosis and discussion about footwear, particularly if you are doing a lot of exercise or higher intensity activities. You will  likely also need something that is going to support the longitudinal section, or the inside part of your foot (orthotic), this will work with the shoe to unload the tendon.

Treatment is based around a careful balance between:

Reduce negative stressors eg high impact, rapid changes or long durations, allowing the tendon unit to repair.

Increase positive stressors e.g. loading and controlled strengthening to increase tendon resilience to future load and use.


Four Stages of Posterior Tibial Tendon Dysfunction

There are four different stages to Posterior Tibial Tendon Dysfunction, and it really depends on when it is diagnosed as to what stage you will be at. Some of the longer term, more severe conditions will require a boot or brace or a combination of boots, orthotics and brace. It can be quite a debilitating condition and it will become painful if left untreated.


How is it Treated?

It is usually treated non surgically, except for the last stage as by this point, there is normally some rigidity in the bones and joints of the foot, and the foot will remain in that flattened sort of position.


This is an example of a highly supportive orthotic used to stabilise the foot in PTTD. With a suitable shoe they work very well and reducing pain and increasing function.

If you think you may have Posterior Tibial Tendon Dysfunction, why not call in and let us have a look? Remember early diagnosis and treatment = better outcomes!

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