Posterior Tibial Tendon Dysfunction (PTTD)

Posterior tibial tendon dysfunction (PTTD) is a progressive condition that affects the foot and ankle. The posterior tibial tendon is a long tendon that attaches from a muscle in the shin, to under the arch of the foot. This tendon is the primary support structure for the arch of the foot. If the posterior tibial tendon becomes damaged or stretched the foot and ankle can deform. The arch of the foot can become visably flatter and the results can be painful and debilitating.

How does the posterior tibial tendon become damaged?

The tendon deformation starts a long time before any symptoms start to show. Over time the tendon is put under more stress than it is capable of supporting. As a result, the repetitive load of weight bearing causes microtrauma, deformation and progressive failure of the posterior tibial tendon.

What are the symptoms of posterior tibial tendon dysfunction (PTTD)?

In the very early stages of posterior tibial tendon dysfunction there are normally no painful symptoms. An individual may notice that they are walking differently, their foot shape has changed or more callus may develop on the soles of their feet.

As the posterior tibial tendon dysfunction progresses, pain and swelling can occur most commonly along the inside of the ankle and foot. This pain can be exacerbated with increased activity levels, such as walking long distances or playing sport. Other symptoms include:

What causes the development of posterior tibial tendon dysfunction (PTTD)?

A number of factors can cause PTTD to develop, such as;

What are the treatment options for posterior tibial tendon dysfunction (PTTD)?

There are 4 stages of PTTD, stage 1 (mild symptoms) to stage 4 (severe symptoms). The treatment options are decided by the stage of condition, severity of the symptoms and any other relevant medical information.

Insoles - Insoles are a crucial treatment option particularly in the early to mid stages of PTTD. An insole can help support the arch of the foot and reduce the stress being put through the posterior tibialis tendon during weight bearing.

Exercises - Specific muscle strengthening exercises can be a useful tool to manage the pain and progression of the condition at any stage. Specific exercises to strengthen the muscles of the foot and ankle including the posterior tibialis muscle can help reduce symptoms.

Splints - There are many types of custom made and ‘off the shelf’ splints that can help in the treatment of PTTD. The splints are particularly useful for individuals who may need increased support for an active lifestyle, are in the later stages of the condition or suffering with painful symptoms.

Orthopedic footwear - orthopedic footwear can be made to offer more support than commercial footwear. Orthopedic footwear can be with extra allowance to accommodate splints and insoles.

Medication - Painkillers and anti-inflammatory medication can help relieve symptoms and reduce inflammation.

Immobilisation - Immobilisation involves completely restricting any ankle of foot movement using a medical walker boot. This can be a useful treatment option if the tendon has been damaged from trauma or if painful symptoms have a sudden onset.

Steroid injections - Steroid injections can help to relieve inflammation.

Surgery - Surgery is normally only considered for those who have exhausted all other non surgrical treatment options or for severe stage 3 or 4 cases of the condition.

What treatment options do Liverpool Orthotics provide for Posterior tibial tendon dysfunction (PTTD

There are many treatment options for PTTD. Our experienced orthotists will identify and diagnose posterior tibial tendon dysfunction and determine the most suitable treatment option.

Liverpool Orthotics provide the very latest in non invasive treatment options. These options include:

Insoles- Liverpool Orthotics provide a range of custom made orthotic insoles. Custom made orthotic insoles conform to the exact shape of the foot. We believe that everyone's feet are individual so a custom made insole is the only way to truly provide the required support for PTTD. Our custom made orthotics are made from a number of different materials depending on the individual’s requirements, lifestyle and the stage of the condition. Liverpool Orthotics provide insoles that can fit inside any commercial footwear.

Footwear - Liverpool Orthotics provide a wide range of stock and custom made footwear. Our footwear can be made to provide additional support. This can be done by using specific stiffeners around the ankle area or by adapting the sole units with wedges or flares. From boots to slippers there are many styles and colours to choose from to suit all tastes. Our footwear can also be made wider and deeper to accommodate splints or specialist insoles.

Splints - Liverpool Orthotics provide a range of custom made and ‘off the shelf’ splints to help with any stage of PTTD. Our experienced orthotist will be able to identify which splint is going to be the most suitable option taking into account the symptoms, stage of condition, lifestyle and individual goals. Well fitted splints can have a positive impact when it comes to reducing pain and preventing further deformation.

Immobilisation - Liverpool Orthotics provide a range of custom and stock immobilisation devices that can rapidly reduce symptoms and enable some mobility.

What does an assessment for posterior tibial tendon dysfunction involve?

The initial assessment can take place at home, work or one of our clinics. One of our experienced HCPC and BAPO registered orthotists will take a relevant medical history and understand the goals of treatment. The orthotist will carry out a full biomechanical assessment including joint range of movement tests, muscle power tests and observations of the walking pattern.

Once the best form of treatment has been determined, the orthotist will take scans, foam impressions and measures to have an orthosis made. A suitable fitting appointment will then be arranged to ensure the device is comfortable. All our orthotic devices come with a complimentary review appointment to ensure that we have achieved the desired outcome of treatment.

To arrange an appointment call Liverpool Orthotics now on 0330 088 3949, or email us at office@liverpool-orthotics.co.uk