Sep 10 2008
Posterior Tibial Tendon Dysfunction
PTTD, or posterior tibial tendon dysfunction, is the compromise of the posterior tibial tendon and a complex group of ligamentous structures which support the arch, resulting in severe foot collapse. The posterior tibial tendon has been thought to be the main structure supporting the arch. In the past, the blame for an acquired flatfoot rested solely on the posterior tibial tendon. It was generally accepted that failure or rupture of the tendon resulted in foot collapse. But, now it is known that the posterior tibial tendon is not the only structure involved in the progressive collapse of the arch in the acquired flatfoot.
Researchers have found that there is involvement of the spring ligament complex, plantar aponeurosis (plantar fascia), deltoid ligament, talocalcaneal ligament, long and short plantar ligament, and medial calcaneal-cuboid ligament. There is a cascading series of events that lead to a collapsed foot and no one structure is solely responsible. This has led to the replacement of the name PTTD with Adult Acquired Flatfoot.
Symptoms: in the early stages of this condition the foot will be sore at the inside of the arch, but it will remain flexible and only mildly weak. As the condition progresses, the arch continues to flatten, the foot rotates in a fixed valgus position and pain may encompass the entire foot and ankle.
Treatments: Custom made orthotics are important for all stages of PTTD, but an AFO (ankle foot orthosis) will do more to control the abnormal motion and stresses on the foot and ankle than an orthotic. Physical therapy may be very beneficial in the early stages. Later stages will need surgery. PTTD or adult acquired flatfoot is not something that can be treated with a simple course of ibuprofen and icing. Over the counter orthotics are not recommended to treat this condition. It is very important to see your doctor as early diagnosis and treatment are essential.
More on flatfeet.
More on PTTD, posterior tibial tendon dysfunction.