Over 60 Million Americans suffer from Adult Acquired Flatfoot
(AAF), otherwise known as Posterior Tibial Tendon Dysfunction
or PTTD. This condition generally occurs in adults from 40-65 years of age, and it usually only occurs in one foot, not both. The Posterior Tibial (PT) Tendon courses along the inside part of the
ankle and underneath the arch of the foot. It is the major supporting structure for the arch. Over time, the tendon becomes diseased, from overuse, and starts to lose it's strength. As a result, the
arch begins to collapse, placing further strain on the PT Tendon, leading to further decrease in tendon strength, which causes further collapse of the arch. This is described as a progressive
deformity because it will generally get worse over time.
Several risk factors are associated with PTT dysfunction, including high blood pressure, obesity, diabetes, previous ankle surgery or trauma and exposure to steroids. A person who suspects that they
are suffering from PTT dysfunction should seek medical attention earlier rather than later. It is much easier to treat early and avoid a collapsed arch than it is to repair one. When the pain first
happens and there is no significant flatfoot deformity, initial treatments include rest, oral anti-inflammatory medications and, depending on the severity, a special boot or brace.
Pain and swelling around the inside aspect of the ankle initially. Later, the arch of the foot may fall (foot becomes flat), this change leads to walking to become difficult and painful, as well as
standing for long periods. As the flat foot becomes established, pain may progress to the outer part of the ankle. Eventually, arthritis may develop.
Your podiatrist is very familiar with tendons that have just about had enough, and will likely be able to diagnose this condition by performing a physical exam of your foot. He or she will probably
examine the area visually and by feel, will inquire about your medical history (including past pain or injuries), and may also observe your feet as you walk. You may also be asked to attempt standing
on your toes. This may be done by having you lift your ?good? foot (the one without the complaining tendon) off the ground, standing only on your problem foot. (You may be instructed to place your
hands against the wall to help with balance.) Then, your podiatrist will ask you to try to go up on your toes on the bad foot. If you have difficulty doing so, it may indicate a problem with your
posterior tibial tendon. Some imaging technology may be used to diagnose this condition, although it?s more likely the doctor will rely primarily on a physical exam. However, he or she may order
scans such as an MRI or CT scan to look at your foot?s interior, and X-rays might also be helpful in a diagnosis.
Non surgical Treatment
Conservative treatment also depends on the stage of the disease. Early on, the pain and swelling with no deformity can be treated with rest, ice, compression, elevation and non-steroidal
anti-inflammatory medication. Usually OTC orthotic inserts are recommended with stability oriented athletic shoes. If this fails or the condition is more advanced, immobilization in a rigid walking
boot is recommended. This rests the tendon and protects it from further irritation, attenuation, or tearing. If symptoms are greatly improved or eliminated then the patient may return to a supportive
shoe. To protect the patient from reoccurrence, different types of devices are recommended. The most common device is orthotics. Usually custom-made orthotics are preferable to OTC. They are reserved
for early staged PTTD. Advanced stages may require a more aggressive type orthotic or an AFO (ankle-foot orthosis). There are different types of AFO's. One type has a double-upright/stirrup attached
to a footplate. Another is a gauntlet-type with a custom plastic interior surrounded be a lace-up leather exterior. Both require the use of a bulky type athletic or orthopedic shoes. Patient
compliance is always challenging with these larger braces and shoes.
If surgery is necessary, a number of different procedures may be considered. The specifics of the planned surgery depend upon the stage of the disorder and the patient?s specific goals. Procedures
may include ligament and muscle lengthening, removal of the inflamed tendon lining, tendon transfers, cutting and realigning bones, placement of implants to realign the foot and joint fusions. In
general, early stage disease may be treated with tendon and ligament (soft-tissue) procedures with the addition of osteotomies to realign the foot. Later stage disease with either a rigidly fixed
deformity or with arthritis is often treated with fusion procedures. If you are considering surgery, your doctor will speak with about the specifics of the planned procedure.