Posterior tibial tendon dysfunction occurs when the posterior tibial tendon of the foot becomes torn or inflamed. Commonly referred to as flat foot, this condition often results in the inability to provide support for the arch of the foot. The posterior tibial tendon is the tendon that attaches the calf muscle to the bones on the inside of the foot and ankle, and is responsible for creating the arch in the feet. This tendon provides the support that normally holds up the arch of the foot while walking. As the tibial tendon tears, individuals often experience pain as the foot gradually rolls inward and flattens. Over time, the supporting ligaments in the foot begin to stretch and tear as well.
Causes of Posterior Tibial Tendon Dysfunction
Posterior tibial tendon dysfunction may be a condition that some people are born with. Other causes may include:
- Stretched or torn tendons
- Nerve problems
- Fractured or dislocated bones in the leg or foot
Posterior tibial tendon dysfunction often occurs in athletes such as basketball and tennis players who may have tears in this tendon from repetitive use. This condition is also more common in women, people who are obese and people with diabetes.
Symptoms of Posterior Tibial Tendon Dysfunction
Some people with this condition may not experience any symptoms at all, however, others may experience:
- Pain along the inside of the foot and ankle
- Limited flexibility
- Pain that intensifies with activity
- Pain on the outside of the ankle
The shape of the foot may also change in individuals with posterior tibial tendon dysfunction, as the heel may tilt outwards and the ankle may roll inwards,as the arch of the foot collapses.
Diagnosis of Posterior Tibial Tendon Dysfunction
Tibial tendon dysfunction is diagnosed through a physical examination and a review of symptoms as well as diagnostic tests that may include X-rays, CT scans or MRI scans.
Treatment of Posterior Tibial Tendon Dysfunction
Initial treatment for posterior tibial tendon dysfunction may include conservative methods that may include:
- Applying ice to the affected area
- Anti-inflammatory medication
- Immobilization through a short cast or walking boot
- Physical therapy
Additional treatment for this condition may also include orthotic devices or braces to support the joints of the foot. In severe cases that do not respond to conservative methods,surgery may be required to cut or realign the bones and correct the deformity. Surgery often involves an osteotomy, which cuts and shifts the heel bone in order to transfer another tendon to be used in place of the torn tibial tendon. Other surgical methods may also include lengthening of the achilles tendon or a fusion of the joints in the back of the foot. Most patients have successful results from surgery.
Left untreated, posterior tibial tendon dysfunction may cause arthritis in the foot and ankle and limitations to physical activity.