P.T. Dysfunction
Description:
The Posterior Tibialis Tendon runs down the inside of the calf, then underneath the inside ankle bone and attaches to the inside of the arch. Posterior Tibialis Tendon Dysfunction (PTTD) refers to a problem of a tendon that is similar to a braded rope that is starting to break and unwind. The job of the tendon is similar to the shocks on a car by stabilizing the foot when your heel first hits the ground. Adult patients or injured patients are the most common groups with this problem.
This condition is associated with other foot / ankle conditions such as:
- Heel spur
- Plantar fasciitis
- Arthritis
- Ankle sprains
- Achilles tendonitis
- Neuroma
- Hammertoes
- Mallet toes
- Stress fractures
- Corns
- Calluses
The pain is characterized as sharp with the first few steps in the morning and also in the evening after increased activities or with minor relief as it is “warmed up” during light walking and massage. The problem can be most noticed where the tendon inserts into the bone on the inner side of the foot. If left untreated, this problem can spread along the rest of the Posterior Tibialis tendon resulting in a locked flattening of the arch of the foot.
Treatment: Conservative Care:
| Shoes: | A shoe with a firm supportive sole is the foundation to the overall conservative treatment of the symptoms and biomechanical problems. |
| Padding: | Soft padding in the arch may provide limited symptomatic relief but is not very effective in correcting the biomechanical problem. |
| Arch support: | Temporary arch supports or molded orthotics will give pressure relief and is the easiest solution for long term treatment with or without surgical intervention. |
| Medication: | Anti-inflammatory medication (Eg. Ibuprofen, Naprosyn) aspirin products, and Acetaminophen can help with the chronic pain, but are not much help with the acute pain. |
| Bracing: | Foot and ankle orthoses or bracing can hold the foot in a better position to relieve the stress on the Posterior Tibialis tendon and the most stable supportive solution with or without surgery. |
Surgical Options:
The type of surgical correction needed depends mostly on how long the problem has been present. Surgery can be as simple as cleaning the inflamed tube around the tendon if the tendon is healthy or as complex as removing the part of the tendon that is completely damaged and stretched out and reconnecting the remaining healthy tendon to the nearby bone. Other procedures to the nearby bones may need to be done during surgery in order to get the best outcome. The incision can vary in size (4cm – 6 cm) and number of incisions depending on the complexity. The procedure is performed in an outpatient facility under sedation and non weight bearing is essential for 3 to 6 weeks after 48 to 72 hours bed rest and foot elevation. Partial weight bearing can begin at 6 to 8 weeks in a walking cast.
