The Adult Acquired Flat Foot Due to Posterior Tibial Tendon Dysfunction

posterior tibial tendon dysfunction

Figure 1 – Posterior Tibial Tendon

One of the worst kinds of flat foot is due to the weakening or rupture of a tendon called the posterior tibialis. The condition is known by several names including posterior tibialis dysfunction (PTD), posterior tibial tendon dysfunction and tibialis posterior dysfunction. The weakening of this tendon leads to an “Adult Acquired Flatfoot” – a progressive flattening of one or both feet.

This condition can lead to severe changes in foot position and function. The collapse of the arch can lead to arthritis, ankle pain, foot pain, fatigue, tendon pain and changes in shape of the foot. It can even cause knee, hip and back pain due to changes in gait.

flat foot posterior tibial dysfunction

Figure 2 – Flat foot secondary to Posterior Tibial Dysfunction

Treatment of Posterior Tibial Tendon Dysfunction – Surgery Should be the Last Resort

We can usually treat PTD with conservative treatment, and surgery is rarely indicated. It is important, however, to be seen as soon as possible for a complete evaluation to help prevent damage to the foot.

Diagnostic testing will include muscle tests, gait evaluation and x-rays. An MRI may be ordered to evaluate the integrity of the tendon. If the tendon is injured we will discuss options for treatment or repair of the tendon. Sometimes a period of immobilization is necessary.

Orthotics for Adult Acquired Flatfoot

flat foot posterior tibial tendon dysfunction

Figure 3 – Flat foot secondary to Posterior Tibial Dysfunction

Most PTD is treated long-term with orthotic devices. Very specialized orthotics are often needed. Those orthotics will usually have:

  • Greater width than average orthotics
  • Increased depth of the orthotic around the heel
  • Specialized wedging against the inside heel to stop the heel from rolling in

All of these features act to offer greater control than standard orthotics as standard orthotic devices usually fail in treating PTD. Sometimes orthotics cannot provide enough control and in those cases we prescribe Ankle-Foot Orthotics (AFOs) and/or shoe modifications for greater control and pain relief.

We are specialists in treating severe flat foot deformities including PTD. Our goal is to treat the problem without surgery. The sooner you visit us, the more likely we will be able to help you with conservative treatment.

heel posterior tibial dysfunction

Figure 2 – Heel does not turn inward with single leg toe rise maneuver due to Posterior Tibial Dysfunction

If you suspect that you or a loved one may have posterior tibialis dysfunction (PTD), contact us today for an appointment in our Seattle office.

A list of articles from the medical literature related to the use of orthotics in the treatment of Posterior Tibialis Dysfunction is available on our bibliography page.

The doctors at the Foot and Ankle Center of Washington are among the Puget Sound area’s best and most experienced in treating flat feet both conservatively and surgically. Don’t live with pain due to flat feet. Contact us today for an appointment in our Seattle office.