Your posterior tibial tendon helps you walk by being one of the major supporting structures in your foot. When this tendon is unable to support the arch, the result is a flattening of your foot. This can happen if the posterior tibial tendon is overused. Runners can experience this condition as well as those who walk long distances, hike or climb stairs.

PTTD is the most common type of flatfoot adults develop. It is often called acquired flatfoot, and it usually occurs in one foot. Occasionally, an individual may develop PTTD in both feet. This condition is progressive if it is not treated early in its development.

Treatment for PTTD often begins with nonsurgical approaches. These may include:

• Orthotic devices or braces used to provide arch support.
• A boot or short leg cast to immobilize the foot, allowing the tendon to heal.
• Exercises and ultrasound therapy may be part of the treatment after wearing a boot.
• Ibuprofen or other NSAIDs may be used to help reduce inflammation and alleviate pain.
• Special inserts for your shoes may be recommended to provide arch support.

Surgery may be recommended when the PTTD is advanced and nonsurgical methods of treatment are not likely to be successful.

Indications for Surgery

When nonsurgical treatment is applied but the condition does not respond after about six months, surgery may be indicated. If you continue to experience pain, Dr. Mogul may recommend surgery to correct problems with the tendon.

The type of surgery needed will depend on where the tendonitis is located and to what degree the tendon is damaged. Types of surgery used to treat PTTD include:

• Lengthening of the Achilles tendon, and it is often performed with other techniques for treatment of flatfoot.
• Cleaning the tendon when the disease is minor and has not changed the shape of the foot.
• Tendon transfer, which is performed in flexible flatfoot to recreate the function of the posterior tibial tendon when it has sustained damage.
• Changing the shape of a flexible flatfoot by cutting and shifting bones.
• Fusion is used when the foot cannot be treated with bone cuts and tendon transfers.

Your doctor will thoroughly examine your foot and study diagnostic images to determine the extent of the PTTD and the most effective treatment for your level of dysfunction. Make an appointment with Dr. Mogul to explore your options for correcting your flatfoot condition.