Posterior Tibial Tendon Dysfunction

The posterior tibial tendon is a large tendon that runs along the inner side of the ankle and foot. Its main job is to support the arch of the foot.

When the posterior tibial tendon does not work properly, there is usually pain and swelling that patients notice on the inner side of the ankle. Additionally, the arch of the foot can collapse and a “flatfoot” may develop. Some refer to this as pronation.

To this end, posterior tibial tendon dysfunction is the most common cause of ‘adult acquired flatfoot deformity’. Often there are no specific event that start the problem, such as a sudden injury. At times it is said that there is “tendonitis”.  This is only partially true. While there may be inflammation (“itis”) there is also tendinosis, or degeneration of the tendon.

Treatment depends on many factors, including the level of pain, the presence of arthritis, and the degree to which the arch has flattened. Initially, most patients are treated with rest and immobilization followed by physical therapy and braces or orthotics.

Most patients get better without surgery. If surgery is necessary, however, a number of different procedures may be considered. These may include ligament and muscle repair or lengthening, tendon transfers, osteotomies (cutting and realigning bones), placement of implants to realign the foot, and joint fusions (removing a joint and allowing two bones to heal together to form one).

If you are considering surgery, your doctor will speak with you further about the specifics of the planned procedure.

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