Just as an old bridge would become unsafe as the structure was compromised, your feet can experience the same. If you have PTTD
and the tendon continues to weaken, it simply won't be able hold up your arch. In
this situation, the arch can fall or collapse, which is referred to as adult-acquired flat foot. You may experience pain and tenderness behind the inside of the ankle. Over time, in addition to the
flattening of the foot, you may also notice a misalignment of the heel so that it no longer aligns underneath the rest of the leg. A tightening of the heel cord, arthritis, and possible deformity of
the ankle joint may also occur. You may feel the discomfort move from the inside to the outside of the ankle as well. Flat foot can also contribute to problems with the plantar fascia, which is the
tendon that runs along the length of your arch.
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing
Symptoms of pain may have developed gradually as result of overuse or they may be traced to one minor injury. Typically, the pain localizes to the inside (medial) aspect of the ankle, under the
medial malleolus. However, some patients will also experience pain over the outside (lateral) aspect of the hindfoot because of the displacement of the calcaneus impinging with the lateral malleolus.
This usually occurs later in the course of the condition. Patients may walk with a limp or in advanced cases be disabled due to pain. They may also have noticed worsening of their flatfoot
The diagnosis of posterior tibial tendon dysfunction and AAFD is usually made from a combination of symptoms, physical exam and x-ray imaging. The location of pain, shape of the foot, flexibility of
the hindfoot joints and gait all may help your physician make the diagnosis and also assess how advanced the problem is.
Non surgical Treatment
Patients can be treated non-surgically with in-shoe devices and braces to hold their feet in the correct position. This can reduce pain and damage and assist with walking. Physical therapy is also
given to improve muscle strength and help prevent injury to the foot. Surgery can be performed if the patient doesn?t find any relief.
Stage two deformities are less responsive to conservative therapies that can be effective in mild deformities. Bone procedures are necessary at this stage in order to recreate the arch and stabilize
the foot. These procedures include isolated fusion procedures, bone grafts, and/or the repositioning of bones through cuts called osteotomies. The realigned bones are generally held in place with
screws, pins, plates, or staples while the bone heals. A tendon transfer may or may not be utilized depending on the condition of the posterior tibial tendon. Stage three deformities are better
treated with surgical correction, in healthy patients. Patients that are unable to tolerate surgery or the prolonged healing period are better served with either arch supports known as orthotics or
bracing such as the Richie Brace. Surgical correction at this stage usually requires fusion procedures such as a triple or double arthrodesis. This involves fusing the two or three major bones in the
back of the foot together with screws or pins. The most common joints fused together are the subtalar joint, talonavicular joint, and the calcaneocuboid joint. By fusing the bones together the
surgeon is able to correct structural deformity and alleviate arthritic pain. Tendon transfer procedures are usually not beneficial at this stage. Stage four deformities are treated similarly but
with the addition of fusing the ankle joint.