When we have foot pain, it isn’t always easy to pinpoint the source because we can’t visualize the structure of all the bones, muscles, and tendons on the inside. The posterior tibial tendon plays an important supportive role within the structure of the foot. It attaches to your calf muscle and then comes down along the inside of your ankle, connecting to the bones inside your foot at the other side. This tendon’s main function is to hold up your arch and support your foot during each and every movement. Every step, run, walk, or jump is made possible with the support from this crucial tendon. While it is designed to perform such an important role, it is vulnerable to stress and injury. A tear during a traumatic injury or stress from overuse can injure the tissues within the tendon. This kind of injury is referred to as posterior tibial tendon dysfunction (PTTD). A really hard fall during a sports game or exposure to a repetitive motion, such as the impact on feet during soccer, tennis, football or basketball, can cause an injury. Flat foot and flat feet in adults can exacerbate this condition. The tendon can experience small tears and become inflamed. If the inflammation is allowed to continue and worsen over time, it will weaken further and could rupture completely.
Posterior tibial tendon dysfunction is the most common cause of acquired adult flatfoot deformity. There is often no specific event that starts the problem, such as a sudden tendon injury. More commonly, the tendon becomes injured from cumulative wear and tear. Posterior tibial tendon dysfunction occurs more commonly in patients who already have a flat foot for other reasons. As the arch flattens, more stress is placed on the posterior tibial tendon and also on the ligaments on the inside of the foot and ankle. The result is a progressive disorder.
Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area. Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time. Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot. Asymmetrical collapsing of the medial arch on the affected side.
It is of great importance to have a full evaluation, by a foot and ankle specialist with expertise in addressing complex flatfoot deformities. No two flat feet are alike; therefore, “Universal” treatment plans do not exist for the Adult Flatfoot. It is important to have a custom treatment plan that is tailored to your specific foot. That starts by first understanding all the intricacies of your foot, through an extensive evaluation. X-rays of the foot and ankle are standard, and MRI may be used to better assess the quality of the PT Tendon.
Non surgical Treatment
Non-surgical treatment includes rest and reducing your activity until the pain improves. Orthotics or bracing help support the tendon to reduce its pull along the arch, thus reducing pain. In moderate to severe cases, a below knee cast or walking boot may be needed to allow the tendon to rest completely and heal. Physical therapy is an integral part of the non-surgical treatment regimen to reduce inflammation and pain. Anti-inflammatory medication is often used as well. Many times evaluation of your current shoes is necessary to ensure you are wearing appropriate shoe gear to prevent re-injury.
In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Symptomatic flexible flatfoot conditions are common entities in both the adolescent and adult populations. Ligamentous laxity and equinus play a significant role in most adolescent deformities. Posterior tibial tendon dysfunction (PTTD) is the most common cause of adult acquired flatfoot. One should consider surgical treatment for patients who have failed nonoperative therapy and have advancing symptoms and deformities that significantly interfere with the functional demands of daily life. Isolated Joint Fusion. This technique is used for well reducible flat foot by limiting motion at one or two joints that are usually arthritic. The Evans Anterior Calcaneal Osteotomy. This is indicated for late stage II adult acquired flatfoot and the flexible adolescent flatfoot. This procedure will address midtarsal instability, restore the medial longitudinal arch and reduce mild hind foot valgus. The Posterior Calcaneal Displacement Osteotomy (PCDO). This technique is indicated for late stage I and early stage II PTTD with reducible Calcaneal valgus. This is often combined with a tendon transfer. A PCDO is also indicated as an adjunctive procedure in the surgical reconstruction of the severe flexible adolescent flatfoot. Soft tissue procedure. On their own these are not very effective but in conjunction with an osseous procedure, soft tissue procedures can produce good outcome. Common ones are tendon and capsular repair, tendon lengthening and transfer procedures. Flat foot correction requires lengthy post operative period and a lot of patience. Your foot may need surgery but you might simply not have the time or endurance to go through the rehab phase of this type of surgery. We will discuss these and type of procedures necessary for your surgery in length before we go further with any type of intervention.