Posterior Tibial Tendon Dysfunction (PTTD)

The posterior tibial (PT) muscle sits deep to your palpable calf muscle. The muscle gives off a tendon that travels on the inside of your ankle and attached to the medial (inside) aspect of your foot.

Its purpose is to support the arch of the foot and provide stability when walking. The PT muscle also assists in inversion of the foot (inward motion).

When the posterior tibial tendon becomes weakened, inflamed, or torn, it can no longer properly support the arch. This condition is known as posterior tibial tendon dysfunction (PTTD), sometimes referred to as “adult-acquired flatfoot.”

PTTD can progress if untreated, leading to arch collapse and arthritis in the foot and ankle joints.

Often PTTD presents concurrently (at the same time) as equinus (tight calf muscles).

Treatment Plan

• Rest/Activity Modification: Avoiding high-impact activities (running, jumping, prolonged standing) helps decrease stress on the tendon.
• Bracing/Orthotics: Often OTC orthotics can relieve pain and pressure, less often custom orthotics are required.
• Stretching: Calf stretches are important to address equinus (tight calf muscles), which worsens flatfoot deformity.
• Strengthening: Specific exercises, especially inversion strengthening (turning the foot inward), help improve tendon function. Though, this strengthening should be saved until after treatment of the acute onset of a flare up.
• NSAIDs: Over-the-counter or prescribed NSAIDs may help reduce pain and inflammation.
• Physical Therapy: A guided program including stretching, strengthening, and balance work can improve function.
• Surgery: Reserved for severe or progressive cases or cases that have not responded to conservative measured. Surgery may involve tendon repair, tendon transfer, osteotomies, or joint fusion, depending on severity.

Avoid:

• Barefoot walking or unsupportive shoes: These increase stress on the tendon and
  arch.
• High-impact activities: Running, jumping, or sports that stress the tendon.

Stretches / Exercises

Important to note that exercises only serve to relieve equinus (tight calf muscles). In many cases the posterior tibial tendon will be difficult to strengthen as it may be attenuated (stretched) or damaged past a point where it can be strengthened.

Foot dorsiflexion stretch with band/belt/towel

1. Be in a comfortable position to allow your leg to stretch out
2. Maintain knee extension (straight leg) position the entire time
3. Take a workout band/belt/towel and wrap the tool around the metarsal heads
   (balls) of your foot
4. Dorsiflex the foot (toes-to-nose) using only your hands, do not use your leg muscles to assist your foot dorsiflexing at any time (picture below)
5. Return to a relaxed position and repeat
6. Complete this stretch for 15-20 repetitions for 3 sets total. Perform exercise 3-5x
   per week during acute plantar fascitis pain. Perform exercise 1x per week once pain
   is gone to maintain pain free plantar fascia