Foot Pain – Posterior Tibial Tendon Dysfunction

Posterior Tibial Tendon Dysfunction

The tibialis posterior muscle plays an important role in supporting the main arch of the foot, turning the foot inwards and pointing it downwards. The tibialis posterior tendon runs down the inside of the ankle and inserts under the foot. Anything that causes an increased load or stress on the tendon can cause it to become inflamed and painful. This is known as posterior tibial tendon dysfunction (PTTD), tibialis posterior tendinopathy or acquired adult flat foot.

Posterior Tibial Tendon Dysfunction - Foot Pain

It is a common condition affecting up to 10% of the population, however it is most common in women aged between 40-50. Most often people who develop PTTD are flat footed to begin with, but something happens to cause the arch to drop further. PTTD can be caused by a trauma or overexertion. Additional risk factors include obesity, diabetes and inflammatory arthritis.

Along with an increased flattening of the arch, symptoms may include pain on the inside of the ankle and instep, inflammation and redness and increased pain on exertion. There are 4 stages of PTTD. Stage 1 the tendon is stretched, stage 2 the tendon has a partial tear and by stage 3 and 4 the ankle becomes stiff and fixed. Whether you can stand on tip toe on the affected side is a sign of what stage the PTTD is at, by stage 2 this will be more difficult and painful and by stage 3 and 4 this is likely impossible.

PTTD is best treated early to prevent progression. Supportive lace up shoes with a flat sole are important for treating PTTD. The addition of an orthotic insert to support the arch and relieve stress and stretch on the posterior tibialis tendon is beneficial. By stage 3 and 4 an ankle brace and potentially surgery may be required.

The insoles we recommend for posterior tibial tendon dysfunction are: PRIMO (1), POSA (2), PELUCHE (3), PROFILO (4), PURA (5) or PRECISO (6).