Posterior tibial tendon dysfunction (PTTD), sometimes referred to as adult acquired flat foot deformity is a musculoskeletal condition whereby the tendon of the tibialis posterior becomes dysfunctional. The tibialis posterior muscle activates during gait to stabilise the arch of the foot and to help slow down and control pronation as the foot strikes the ground. Therefore, when the tendon becomes dysfunctional the arch of the foot is more likely to flatten and over pronation becomes more likely. When this occurs the foot becomes more unstable as the mid foot is subject to mechanical overloading, both from body weight and the contraction of the calf muscles which causes a powerful pronation moment. As a result of these abnormal stresses, ligaments and soft tissue structures in the foot can stretch and deform over time (acquire a flat foot). Posterior tibial tendon dysfunction can be very painful.
Risk factors include pre-existing flat foot, age, obesity, female gender, sedentary lifestyle, diabetes high blood pressure, previous trauma and inflammatory diseases.
Stage 1: No deformity, Mild weakness (able to complete single leg heel raise)
Stage 2: Flexible flat foot deformity Significant weakness (difficulty to complete single leg heel raise)
Stage 3: Fixed flat foot deformity Complete inability to perform a single leg heel raise
Stage 4: Fixed flat foot with valgus (foot rolled in) position Arthritis of the Ankle
The aim of Orthotic treatments for PTTD is to decrease the pain you experience by maintaining a neutral foot and ankle position and prevent or postpone progression of deformity (flat foot). Orthotics can be used successfully for the majority of PTTD patients.
Orthotic treatment choices for PTTD vary based on the clinical presentation, symptoms and patient activity level. Sometimes PTTD has progressed to the level where orthotics may have little impact and at this stage surgery maybe considered.
The photo on the right shows how an orthotic can be used to maintain the architecture of the foot and help to protect against it flattening.
We can assess your foot and lower limb function during a biomechanical assessment to see if orthotics may provide effective treatment for your foot pain.