PTTD is a common condition treated by foot and ankle specialists. Although there is a role for surgical treatment of PTTD, conservative care often can prevent or delay surgical intervention.
Decreasing inflammation and stabilizing the affected joints associated with the posterior tibial tendon
pain and increase functional levels. With many different modalities available, aggressive nonoperative methods should be considered in the treatment of PTTD, including early immobilization, the use
of long-term bracing, physical therapy, and anti-inflammatory medications. If these methods fail, proper evaluation and work-up for surgical intervention should be employed.
Many health conditions can create a painful flatfoot, an injury to the ligaments in the foot can cause the joints to fall out of alignment. The ligaments support the bones and prevent them from
moving. If the ligaments are torn, the foot will become flat and painful. This more commonly occurs in the middle of the foot (Lisfranc injury), but can also occur in the back of the foot. In
addition to ligament injuries, fractures and dislocations of the bones in the midfoot can also lead to a flatfoot deformity.
Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area. Pain that is worse with activity. High-intensity or high-impact
activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time. Pain on the outside of the ankle. When the foot collapses, the heel bone may
shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot. Asymmetrical collapsing of the medial arch on
the affected side.
Observation by a skilled foot clinician and a hands-on evaluation of the foot and ankle is the most accurate diagnostic technique. Your Dallas foot doctor may have you do a walking examination (the
most reliable way to check for the deformity). During walking, the affected foot appears more pronated and deformed. Your podiatrist may do muscle testing to look for strength deficiencies. During a
single foot raise test, the foot doctor will ask you to rise up on the tip of your toes while keeping your unaffected foot off the ground. If your posterior tendon has been attenuated or ruptured,
you will be unable to lift your heel off the floor. In less severe cases, it is possible to rise onto your toes, but your heel will not invert normally. X-rays are not always helpful as a diagnostic
tool for Adult Flatfoot because both feet will generally demonstrate a deformity. MRI (magnetic resonance imaging) may show tendon injury and inflammation, but can?t always be relied on for a
complete diagnosis. In most cases, a MRI is not necessary to diagnose a posterior tibial tendon injury. An ultrasound may also be used to confirm the deformity, but is usually not required for an
Non surgical Treatment
Initial treatment consists of supporting the medial longitudinal arch (running the length of the foot) to relieve strain on the medial soft tissues. The most effective way to relieve pain on the
tendon is to use a boot or brace, and once tenderness and pain has resolved, an orthotic device. A boot, brace, or orthotic has not been shown to correct or even prevent the progression of deformity.
Orthotics can alleviate symptoms and may slow the progression of deformity, particularly if mild. The deformity may progress despite orthotics.
In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Surgical
treatment may include repairing the tendon, tendon transfers, realigning the bones of the foot, joint fusions, or both. Dr. Piccarelli will determine the best approach for your specific case. A
variety of surgical techniques is available to correct flexible flatfoot. Your case may require one procedure or a combination of procedures. All of these surgical techniques are aimed at relieving
the symptoms and improving foot function. Among these procedures are tendon transfers or tendon lengthening procedures, realignment of one or more bones, or insertion of implant devices. Whether you
have flexible flatfoot or PTTD, to select the procedure or combination of procedures for your particular case, Dr. Piccarelli will take into consideration the extent of your deformity based on the
x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.