Posterior Tibial Tendon Dysfunction
The Highlights
Tibialis Posterior Dysfunction is an overload injury to the main dynamic arch-stabilising tendon of the foot, often resulting in pain below the inner part of the ankle and arch.
In our clinic, we can diagnose this problem easily with physical examination and occasionally with the added use of diagnostic ultrasound.
As a progressive condition, it is essential we treat this as soon as we can. Foot orthoses (specialist insoles) are a mainstay for offloading the tendon as are appropriate shoes and boots. There is also a focus rebuilding strength and load-tolerance in the tendon through progressively more difficult exercises. In ongoing or more severe cases we can also look at more advanced treatment options like Richie Brace therapy and ultrasound-guided injection therapies.
What is it and what are the symptoms?
Tibialis Posterior Dysfunction (TPD) or Posterior Tibial Tendon Dysfunction (PTTD) is one of the most common tendon problems we see in our practice and therefore one we have a huge amount of experience treating. It is the progressive decrease in tendon health, usually behind your medial malleolus (the bony prominence on the inside of your ankle) and/or at the attachment on to the navicular bone. It results in pain, difficultly walking (lifting the heel off the ground in particular) and, if left unmanaged, the development of an acquired flat foot deformity.
Pain is typically in the locations already mentioned and if the tendon sheath is inflamed then pain may run along it's full course. Symptoms of tendinopathy can vary depending on severity of injury and the length of time you have had it. Common features include pain in the tendon when first moving from a rested position or beginning activity like a run. A lot of people will report the pain eases once they get going. There may also be swelling around the inside of the ankle. The pain is usually a dull ache but when aggravated it can feel quite sharp.
Why does it happen?
Like other tendinopathies, the ultimate driver of TPD is an ability for the tendon to keep up with the demands placed upon it, being unable to adapt and heal sufficiently. The locations where the tendon becomes damaged tend to be at it's points of maximum friction as is passes behind the medial malleolus, suggesting this might be an important factor. The mechanical function of some people's feet and lower limbs can also place high loads on this tendon which we will seek to address in treatment.
What are the treatment options?
We ascribe to the idea of TPD being a medical emergency of sorts; the evidence is very clear - if left untreated, this condition will almost certainly worsen and lead to permanent deformity and disability. For that reason we advise anyone worried about having this problem to see someone who knows what they're doing (we like to think that's us!) without delay. Our director and clinical lead, Robert McCririck, has a special interest in this condition having suffered from it himself!
Foot orthoses (specialist insoles) are very important in almost all cases for at least the short- to medium-term and often over a longer period. There is perhaps no better example of a condition where this is more true. Our team are exceptionally skilled at assessing and prescribing foot orthoses for this problem and can offer both off-the-shelf and more bespoke custom-made options to suit your needs. Exercise therapy to strengthen the tibialis posterior tendon and associated tissues also plays an important role.
As part of our mission to bring the most advanced Podiatry practices to the Scottish Borders we also offer options for more complex or longstanding versions of this condition including fully-bespoke Richie Brace therapy and ultrasound-guided injection therapies.
