Orthotic Management of Posterior Tibialis Tendon Dysfunction:
Posterior Tibialis Tendon Dysfunction (PTTD) is a musculoskeletal condition characterised by a dysfunction of the Tibialis Posterior muscle. It is a common condition in adults and often referred to as adult acquired flat foot.
The Posterior Tibialis is the main stabiliser of the medial foot arch and when it becomes damaged this increased flexibility can lead to mechanical overload when walking. Even a small stretch of this tendon can affect muscle function and medial arch control.
- Gender, more common in females.
- Existing flat footed posture.
- Sedentary life style.
- Previous ankle or tibialis injury.
- Pain in the ankle and medial arch which worsens with activity.
- Pain which extends along the inside of the foot and ankle, this follows the line of the tendon.
- Swelling or bruising in the foot and ankle.
- A change in foot posture. The foot can appear more flat footed.
There are many orthotic options available for the treatment of PTTD and treatment will depend on the level of injury to the Posterior Tibialis. The overall goal is to support the medial arch to reduce strain across the affected tendon or accommodate long term foot and ankle posture. The aim will be to:
- Reduce pain.
- Facilitate increased function and activity.
- Improve and support foot posture.
- Prevent progression of the deformity.
- Accommodate fixed deformities.
This is the acute stage of PTTD and requires immobilisation in a walking boot for up to six weeks. This is to restrict excessive movement at the foot and ankle, to protect the ligaments and tendon structures, and to aid healing and reduce inflammation. This is followed by long term wear of arch support insoles.
At this stage the deformity is fairly stable and the joints remain flexible. Moulded insoles are commonly used to support foot posture and stabilise along the medial arch to reduce stress and strain and the Posterior Tibialis. For best results these are custom made to a scan or mould of the foot with additional wedging under the medial heel for increased stability. However, there is a large range of stock insoles available to support the medial arch.
At this stage low profile, lightweight, flexible braces can also be worn for stability and to manage the symptoms associated with PPTD.
At this stage the deformity is starting to lose some flexibility and a more rigid support is required to stabilise and support foot posture. These can be in the form of a rigid articulating ankle brace or a custom made ankle support.
At this stage a rigid support is require to accommodate the food posture due to the fixed posture of the foot and ankle. The foot will be in a rigid fixed position and care must be taken not to try and correct foot posture which can lead to blisters and skin breakdown. Custom made footwear with a caliper and strapping adaptions can be used to facilitate increased mobility. Rigid ankle foot splints (AFOs) can also be worn shaped to the foot posture to help relieve pain.
If you would like any further information on our any of our braces then you can call us to speak with one of our Orthotists on 07751 370949, visit our website at www.totalbodyorthotics.com or visit us at our clinic. Our experienced clinicians are able to offer a full lower limb biomechanical assessment and provide treatment advice on the best orthotic device to suit your individual needs.