POSTERIOR TIBIAL TENDON DYSFUNTION (PTTD) - ADULT ACQUIRED FLATFOOT  

What is a Flatfoot?

Flatfoot is often a complex disorder with diverse symptoms and varying degrees of deformity and disability.  There are several types of flatfoot, all of which have one characteristic in common-partial or total collapse (loss) of the arch.

Other characteristics shared by most types of flatfoot include:

·  “Toe drift,” where the toes and front part of the foot point outward

·  The heel tilts toward the outside and the ankle appears to turn in

·  A short Achilles tendon, which causes the hell to lift off the ground earlier when walking and may act as a deforming force

·  Bunions and hammertoes may occur in some people with flatfeet

Health problems such as rheumatoid arthritis or diabetes sometimes increase the risk of developing flatfoot.  In addition, adults who are overweight frequently have flatfoot.

What is PTTD?

Posterior tibial tendon dysfunction (PTTD) is an inflammation and / or overstretching of the posterior tibial tendon in the foot.  An important function of the posterior tibial tendon is to help support the arch.  But in PTTD, the tendon’s ability to perform that job is impaired, often resulting in a flattening of the foot. 

PTTD is often called “adult-acquired flatfoot” because it is the most common type of flatfoot developed during adulthood.  Although this condition typically occurs in only one foot, some people may develop it in both feet.  PTTD is usually progressive, which means it will keep getting worse-especially if it isn’t treated early.

This differs from flexible flatfoot because flexible flatfoot typically begins in childhood or adolescence and continues into adulthood.  It usually occurs in both feet and generally progresses in severity throughout the adult years.  As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and become inflamed.

The term “flexible” means that while the foot is flat when standing (weight bearing), the arch returns when not standing.  In the early stages of flexible flatfoot arthritis is not restricting motion of the arch and foot, but in the later stages arthritis may develop to such a point that the arch and foot become stiff.

Symptoms of PTTD

The symptoms of PTTD may include pain, swelling, a flattening of the arch, and inward rolling of the ankle.  As the condition progresses, the symptoms will change.  For example:

·  Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle.  But at this point, the foot and toes begin to turn outward and the ankle rolls inward

·  As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle.  The tendon has deteriorated considerably and arthritis often develops in the foot.  In more severe cases, arthritis may also develop in the ankle.

            Symptoms, which may occur in some persons with flexible flatfoot, include:

·  Pain in the heel, arch, ankle, or along the outside of the foot

·  “Turned-in” ankle

·  Pain associated with a shin splint

·  General weakness / fatigue in the foot or leg.

Treatment Options

·  Activity modifications

·  Weight loss

·  Shoe modifications

·  Surgery

Treatment of Adult Flatfoot

Non-surgical Approaches:

·  Orthotic devices or bracing

·  Immobilization

·  Physical therapy

·  Medications

·  Shoe modification

Because of the progressive nature of PTTD, it’s best to see your foot and ankle surgeon as soon as possible.  If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested.  In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities.

When is Surgery Needed?

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. 

Flatfoot Surgery

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.