South West Orthopedic Designs

Innovations in Design and Fabrication

Posterior Tibial Tendon Dysfunction

Definition:

This is one of the more common tendon disorders about the ankle. Posterior Tibial Tendon Dysfunction (PTTD) is an alteration of the function of the posterior tibial tendon. This may be due to a rupture, laceration, inflammation, abnormal insertion, or attenuation of the tendon. With dysfunction of the tendon there can be excessive pronation of the foot and an acquired flatfoot.

Functional Anatomy:

The posterior tibial tendon helps support the arch of the foot and provides power to point the foot down and to turn the foot inward.

Symptoms:

Posterior tibial tendon dysfunction is usually pain with walking/standing as well as a noticeable flatting of the foot while walking/standing. There maybe increased shoe irritation in the arch of the foot as the foot is allowed to excessively pronate or roll inward.

Patients often experience tenderness and inflammation along the inner part of the ankle.  They note weakness when standing on their toes.

As the disease progresses, patients describe loss of the arch of the foot while standing.  Patients often note continued pain and inflammation.  The foot tends to turn outward with weight bearing.

Late stage disease includes a flat foot deformity with degenerative changes in the joints below the ankle.

• Stage I
  
  Tendon Status:
  Attenuated (lengthened) with tendonitis but no rupture.
  Clinical Findings:
  Palpable pain in the medial arch. Foot is supple, flexible with "too many toes" sign.
  X-ray/MRI:
  Mild to moderate tenosynovitis on MRI, no X-ray changes.
  
  
• Stage II
  
  Tendon Status:
  Attenuated with possible partial or complete rupture.
  Clinical Findings:
  Pain in arch. Unable to raise on toes. Too many toes sign present.
  X-ray/MRI:
  MRI notes tear in tendon. X-ray noting abduction of forefoot, collapse of talo-navicular joint.
  
  
• Stage III
  
  Tendon Status:
  Severe degeneration with likely rupture.
  Clinical Findings:
  Rigid flatfoot with inability to raise up on toes.
  X-ray/MRI:
  MRI shows tear in tendon. X-ray noting abduction of forefoot, collapse of talo-navicular joint.
  
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Innovations in Design & Fabrication

South West Orthopedic Designs, LLC
2010 West Parkside Lane, Suite 148
Phoenix, AZ 85027

Phone: (480) 703-9433 Fax: (623) 434-5882

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Copyright© 2002 South West Orthopedic Designs, LLC. All Rights Reserved. Last updated Sept. 2009.