Tag: adult-onset flat foot

Posterior Tibial Tendon Dysfunction (Adult-Acquired Flat Foot)

Noticed that your foot is getting flatter and more painful? Do you have difficulty walking or performing exercise activity without leg and arch pain? Have you heard the term “fallen arches”? All of these things refer to a condition known as posterior tibial tendon dysfunction. This is an inflammation and overuse syndrome of one of the long tendons that pass from the leg around the inside of the ankle and attaches to the inside arch of the foot. The posterior tibial tendon’s job is to help support the arch and allow for more efficient gait.

PTTD is most commonly seen in adults and referred to as “adult acquired flatfoot”. Symptoms include pain and swelling along the inside arch and ankle, loss of the arch height and an outward sway of the foot. If not treated early, the condition progresses to increased flattening of the arch, increased inward roll of the ankle and deterioration of the posterior tibial tendon. Often, with end stage complications, severe arthritis may develop.

How does all this happen? In the majority of cases, it is overuse of the posterior tibial tendon that causes PTTD. And it is your inherited foot type that may cause a higher possibility that you will develop this condition.

Non-surgical treatment includes rest and reducing your activity until the pain improves. Orthotics or bracing help support the tendon to reduce its pull along the arch, thus reducing pain. In moderate to severe cases, a below knee cast or walking boot may be needed to allow the tendon to rest completely and heal. Physical therapy is an integral part of the non-surgical treatment regimen to reduce inflammation and pain. Anti-inflammatory medication is often used as well. Many times evaluation of your current shoes is necessary to ensure you are wearing appropriate shoe gear to prevent re-injury.

For those patients with PTTD that have severe deformity or have not improved with conservative treatments, surgery may be necessary to return them to daily activity. Surgery for PTTD may include repair of the diseased tendon and possible tendon transfer to a nearby healthy tendon, surgery on the surrounding bones or joints to prevent biomechanical abnormalities that may be a contributing factor or both.

Posterior Tibial Tendonitis

Many people have begun a vigorous exercise program to start their New Year’s resolution of losing weight and getting in shape. But with this, comes unexpected pain that stops the workout sessions and ultimately prevents them from fulfilling their goal. Most often this is due to “too much, too soon, too fast” syndrome.

Pain along the inside of the ankle that extends to the inside arch is often due to strain of the posterior tibial tendon. The main job of this tendon is to prevent overpronation of the foot and stabilize the arch and ankle. Overuse of this tendon, particularly in people with flat feet, causes the tendon to swell and become painful so that exercise activity is not possible. Ultimately, this type of injury can lead to tear of the tendon and possible surgery. The pain is often sharp, stabbing and radiates along the course of the tendon. Often the entire ankle will be swollen.

Treatment for this begins with rest. This doesn’t mean you have to stop exercising, but no weight bearing exercise until the pain subsides. Ice daily and apply compression to reduce swelling. When pain is gone, then gradual return to an exercise program with appropriate shoes and brace as needed.

A complete lower extremity exam will help determine what types of shoes are best for your workouts and what type of inserts can prevent recurrence of the pain. Often with flat feet, custom orthotics are the best devices that support the ankle and arch and prevent overpronation, thus reducing the likelihood that the pain will return.

If left untreated, posterior tibial tendonitis leads to tear of the tendon (a.k.a. Adult-onset flat foot) and often extensive foot and ankle surgery. It is best to treat this pain as early as possible.