A condition that occurs in adulthood and is called, "posterior tibial tendon dysfunction" or "PTTD". This condition causes pain in the arch of the foot, inside the ankle and occasionally into the lower leg. One of the common identifiers of this conditioner is a collapsed arch or “flat foot.” PTTD usually starts as an overuse condition but then gets worse over time. Other causes include:
In PTTD, the posterior tibialis muscle (located on the inside of the lower leg) is overused and becomes inefficient with arch control. This causes tendon inflammation and subsequent damage to the posterior tibialis tendon. Common activities that become painful include running, walking, walking on uneven surfaces and stair climbing.
There are four progressive stages related to PTTD:
Stage 1: Tendon inflammation is present but arch control remains. Walking is painful and limited.
Stage 2: Damage to the tendon begins to occur. You start to lose arch control at this stage. Activity tolerance decreases but you still have some muscle strength in the posterior tibialis.
Stage 3: Due to consistent tendon damage, arch control is lost and changes at the ankle joint occur. At this stage, you may start to posterior tibialis function.
Stage 4: The function of the posterior tibialis is lost and arthritic changes occur at the ankle.
How does Physical Therapy help PTTD?
Physical Therapy can help at any stage of PTTD but the earlier you receive treatment, the better your prognosis. The effects of PTTD can be reversible in early stages but are usually more permanent as the dysfunction progresses.
In early stages of PTTD, therapy will focus on restoring ankle range of movement, improving ankle and lower extremity strength, balance and gait training, pain management, addressing potential factors contributing to your pain, and may include short term solutions like orthotics or bracing.
Therapy received at later stages will include activity modification, improving ankle mobility and strength, pain management techniques, and more permanent solutions including ankle bracing, rigid shoes or a walking boot.
As Physical Therapists we have had extensive experience in treating PTTD and have seen great results in treating this condition, particularly when its addressed early.