Introduction
Posterior tibial tendon dysfunction, often referred to as acquired flatfoot, occurs when the tendon located at the back of the ankle becomes inflamed or torn. This condition is progressive and can lead to a fallen arch or flatfoot over time. In advanced cases, or those that don’t respond to non-surgical treatments, surgery may be necessary. Multiple surgical options are available for treating posterior tibial tendon dysfunction, and it is common for patients to require more than one procedure.
Anatomy
The posterior tibial tendon originates in the calf, wraps around the inner side of the ankle joint, and attaches to the midfoot bones. Its primary role is to maintain the foot's arch and provide stability during walking.
Causes
This dysfunction arises from inflammation or tearing of the tendon. Contributing factors include sports injuries and overuse, as well as certain medical conditions like obesity, hypertension, diabetes, and arthritis, which increase the risk. Women are particularly more susceptible to issues with this tendon.
Symptoms
Posterior tibial tendon dysfunction typically develops in one foot, although both feet can be affected. Symptoms tend to worsen progressively, starting with pain, redness, and swelling along the inner ankle and foot. As the arch flattens, individuals may experience pain in the outer and midfoot, weakness, and difficulty standing on their toes.
Diagnosis
If you suspect you have posterior tibial tendon dysfunction, it's important to consult your doctor. Early diagnosis and intervention can help halt the condition's progression. A diagnosis is made by evaluating your medical history, conducting a physical examination, and performing various tests. Your doctor may ask you to stand or move your foot in specific ways to assess tendon function. Imaging techniques such as X-rays, ultrasound, or MRI may be utilized to visualize the structures of your ankle and leg.
Treatment
Early non-surgical treatments can sometimes avert the need for surgery in the future. Initial treatment for pain and swelling may involve rest and the use of pain relievers like aspirin or ibuprofen. A short leg cast or boot might be recommended while the tendon heals, followed by physical therapy to restore range of motion and strength. Additionally, you may be provided with ankle stirrups, custom orthotic devices, or specialized shoe inserts for added foot support.
Surgery
Surgery is considered when non-surgical treatments fail to alleviate symptoms or in advanced cases of the condition. Multiple surgical techniques exist, and patients may need more than one type of procedure. Surgical options can include removing inflamed tissue, realigning the heel bone, tendon transfer for reconstruction, or fusing bones to enhance stability and limit movement.
Recovery
Post-surgery, you may need to wear a protective splint, cast, or boot. Rehabilitation exercises will aid in regaining strength and stability, and you may initially require a cane or crutches. Recovery times vary based on the severity of your condition and the specific procedures performed. Your doctor will guide you on what to expect during the healing process.
Prevention
Early diagnosis and treatment can help prevent the progression of posterior tibial tendon dysfunction. It is advisable to use arch supports, custom orthotic inserts, or specially designed shoes as recommended by your healthcare provider.
