Posterior Tibialis Tendon Dysfunction (PTTD) is also known as tibialis posterior tendonitis, tibialis posterior insufficiency, adult acquired flat foot and even “blown out ankle.” Although it can be caused by trauma to the tendon, it is largely found in those who overpronate. The tibialis posterior muscle and tendon are overstretched, leading to the tendon pulling away from the navicular. If the initial discomfort is ignored the tendon can rupture, resulting in a complete flattening of the foot. It can appear that the person is walking on their anklebone. Normal standing and walking aggravate the condition.
Physicians use a scale of 1-4 to document the severity of the disorder. Unfortunately, once the condition starts, it requires life long management to keep it from progressing. Bracing, from the softer varieties up to California/Arizona braces, are used to keep the foot in a supported position while walking.
Other names or similar foot conditions:
- Tibialis posterior tendonitis or insufficiency
- Adult acquired flat foot
- Blown out ankle
Symptoms:
- Begins as medial leg pain, like a shin splint
- The midfoot falls, exaggerating the flat foot.
- Acute discomfort in ankle and foot when walking or standing.
Signs to look for:
- Ankle and cuboid bone flatten and protrude inward
- Foot scans show both feet flat, but the collapsed foot will exhibit pressure in the medial arch area.
- The arch literally disappears.
Possible Causes:
- Heredity may produce the lower arched foot
- Overuse of tibialis posterior muscle, such as in high impact recreational activities
- Injury
- Soft shoes with minimal support worn over a long period of time.
- Steroid/cortisone shots may contribute to a breakdown of the tendon over time
Goals:
- Support for the arch that will correct motion of the foot during gait
- Restore alignment to the ankle, top of the foot and knees
- Shoes that do not allow lateral motion at the heel
How We Help:
Arch Supports:
- BioOrthotics exercising support with metatarsal lift
- Lower and thinner orthotic with longitudinal and metatarsal support when wearing shoes that cannot accommodate the BioOrthotics exercising support
Shoes:
- Extra depth, double or triple depth shoe with high toe box, firm heel counter, rocker sole and connecting shank
- Straight last
- Smart shoes, such as heel to toe rockers, negative heel shoes or shoes with titanium springs
- Avoid pumps and heels
- Go barefoot on a minimal basis only.
Other:
Medical treatment and supervision, including temporary or permanent bracing
Activities:
- Ankle and leg exercise on a circular “stability” disc
- Regular walking causes pain and aggravates the condition. An exercise program should include low to no impact equipment and/or a Pilates type program
- Regular stretching of the gastrocnemius and soleus muscles, the Achilles tendon and arch structures.
- Neuro-muscular massage.
This information does not constitute a diagnosis of your condition and does not take the place of a doctor’s care. The information has been compiled from sources available to the general public and referenced below. Copyright 2007-2010 Carole Romig
Sources Image: FootCenterof Manhatten.com, A. Decker, S. Albert, Contemporary Pedorthics Text: B. Meanwell, CPed, G. Copeland, DPM, The Foot Book,, D. Janisse, CPed, Editor, Introduction to Pedorthics