Posterior Tibial Tendon dysfunction/ Acquired flat foot.

The posterior tibial tendon connects one of the muscles on the back of the lower legs to the bones in the centre of the sole of the foot. It is located deep behind the calf muscles.

The posterior tibial muscle is responsible for the downward and inward movement of the foot.  While the tendon helps to stabilise the structures at the bottom of your foot and your arch, it does not contribute to the structure of the foot itself.

Posterior tibial tendon dysfunction (PTTD) is a disabling condition caused by the loss of function of the tibialis posterior tendon.

What are the causes?

It is unknown what causes tibialis posterior dysfunction, but several factors have been linked to its development. Included are:

  • Obesity
  • Flat foot type
  • Inflammatory joint diseases such rheumatoid arthritis, degenerative rupture.
  • Previous surgery or trauma to the area.
  • Excessive foot pronation
  • Diabetes
  • Exposure to steroids, local steroid Injections to the area.

What part of the population is mostly affected?

It typically affects women between the ages of 40 and 60. Additionally, it is connected to prolonged standing, walking, and running. Approximately 2.3% to 3.6% of runners are affected by this condition.

The dysfunction of the posterior tibial tendon is a common cause of Acquired Flatfoot deformity.

What are the signs and symptoms?

In the early stage, you may experience pain on the inside aspect of the ankle. You will not see foot deformity at this stage.  Instead, you might experience pain, swelling, redness, and tenderness as well as warmth along the tendon’s path. 

The tendon may lengthen or rupture as the condition progresses. The foot flattens and becomes rigid. More tendon damage results from your foot flattening which causes complete tendon degeneration and a rise in the angle of your ankle relative to the outside of your body.

This loss of the height of the arch results in a deformity known as Acquired Flatfoot deformity. Typically, this transformation occurs on one leg. You will notice that the affected leg will lose strength and flexibility.  This is extremely painful, so you will be unable to stand on your toes.

To find out more about treating and preventing posterior tibial tendon dysfunction/ acquired flat foot deformity download our guide Posterior Tibial Tendon Dysfunction

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