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You know what they say (and by “they” we mean Joni Mitchell): you don’t know what you’ve got ‘til it’s gone. That is very much the case when posterior tibial tendon dysfunction (PTTD) starts to cause pain and trouble within your foot and ankle.
PTTD is certainly a mouthful when you don’t abbreviate it, but what is happening inside your foot is actually not too complicated. And the sooner you do something to address that problem, the less severe an effect it can have on you over time.
What Does PTTD Feel Like?
The primary symptoms of PTTD are:
- Pain experienced along the inside of the ankle and foot.
- Pain on the outside of the ankle.
- Pain that becomes worse with activity – especially high-impact activities such as running. Standing or moving around for a long time can also start to become troublesome.
You may see some swelling too, but not always.
Now, painful symptoms such as these can indicate a number of different problems, but one truth always remains clear: never put off getting help for any consistently occurring pain, no matter where it is or when it happens. Your body’s “Check Engine” light is on and needs to be checked before something worse is allowed to happen.
What is Going On with PTTD?
Posterior tibial tendon dysfunction, as you might have already surmised, deals primarily with the posterior tibial tendon.
While the Achilles tendon tends to get the most attention in this area of the body, the posterior tibial tendon is also a very important player. It connects the calf muscles in the lower leg to the bones on the inside of the foot. This keeps the tissues of the arch stable and supports the foot as you walk.
In fact, you can see the tibial tendon in this video on the Achilles. Look for the bulge on the left side of the foot.
You can think of the posterior tibial tendon as similar to the ropes that hold up a drawbridge. As long as it is able to do its job properly, it works very well. But when something starts to stress or tear the tendon, it starts to weaken, and the arch can suffer for it.
The more the arch collapses, the more stress is placed on the tendon and the more it can strain. Several factors can contribute to this cycle:
- Abnormalities in foot structure, which are often inherited
- Excess weight on the tendon and arch
- Repetitive stress from running and other activities
- An acute injury that damages and/or inflames the tendon
Pain on the inside of the ankle is often attributable to the tendon itself being injured and inflamed. But what about that pain on the other side of the ankle? As the arch collapses, the heel bone can shift outward, putting pressure on that area.
An Increasingly Troubled Tendon
The posterior tibial tendon degrades over time, and this degradation can be divided into stages. Once again, the sooner you start to address the problem, the better!
- Stage 1: Mild-to-moderate pain is felt in the ankle or arch. It still responds well to rest during this time.
- Stage 2: Pain increases. Lifting your heels can especially cause tenderness in the ankle.
- Stage 3: Raising just one heel can become too painful. The joints have become irritated and chronic inflammation is starting to cause the tendon to outright deteriorate.
- Stage 4: The joints, for lack of a better term, are trashed. Deterioration accelerates and disaster is all but imminent.
In the first two stages of PTTD, treatment is much simpler. We can decrease the loads on your tendon and associated structures by addressing any biomechanical issues you may have and focusing on activity levels and weight management, if necessary. If you can lighten the load and keep the tendon in the proper position, healing tends to happen naturally.
By the time stages 3 and 4 have arrived, treatment largely depends on how much damage is present. By this point, we must limit losses as much as possible. Doing so from the outside, using bracing or foot-ankle orthoses, is preferable. But if that does not prove effective, surgery may be required to fuse failing joints.
Fight the Future
Abnormalities that can contribute to PTTD can be visible very early on, even in early childhood. The good news, however, is that children’s feet are still quite malleable during this time and corrections can be made rather easily.
So if you’re a grandparent with PTTD, keep an eye on your grandchildren. If they’re inheriting the same types of structural problems you are, it’s a good idea to have them checked out early. We’re more than happy to discuss what to look for with you.