Posterior Tibial Tendon Dysfunction in Sugar Land
The posterior tibial tendon plays a crucial role in supporting the arch
and providing stability to the foot. Dysfunction of this important combination
of muscle and tendon may result in a severe flatfoot deformity. There
is a broad spectrum in the symptoms of a patient with posterior tibial
tendon dysfunction, ranging from a painful, well-aligned foot to a severe
flatfoot. Most typical is the patient who presents early in onset and
complains of painful swelling behind the inner ankle that may radiate
to the arch.
X-rays may be taken of your foot during an examination. Even though x-rays
will not image the tendon itself, they are of great value in assessing
positional bony relationships and arthritic or adaptive changes. MRI studies
provide much more information about the extent of damage to the tendon.
Classification is necessary and essential for the treatment of the dysfunction:
- Stage I- asymptomatic phase, results from an underlying biomechanical fault
that predisposes one to develop PTTD
- Stage II- symptomatic phase with the development of tendonitis, mild symptoms,
and progressive flatfoot deformity
- Stage III- characterized by tendon rupture, either complete or partial,
severe symptoms, and a disabling flatfoot condition. The tendon and deformity
may be reconstructable during this stage
- Stage IV- demonstrates rapid progression of the severely disabling arthritic
Conservative treatments are recommended in stages I and II. In the acute
or early stages, treatment is directed at reducing inflammation and removing
stress to the tendon in the hope that the damaged tendon will heal. Nonsteroidal
anti-inflammatory drugs (NSAIDS) may be beneficial in providing pain relief
and in reducing inflammation. Oral steroids may be indicated for short-term
treatment of the acute inflammation in some patients. Physical therapy
may be utilized to resolve inflammation and to strengthen the tendon.
Often immobilization may be required with a cast, cam- walker, or braces.
Surgery is usually recommended for stages III and IV. Soft tissue procedures
for the treatment of tibialis posterior tendon dysfunction revolve around
two primary components: repair of the tibialis posterior tendon, and restoring
stability to the foot.
Recent medical advances have developed new techniques in flexible flatfoot
caused by PTTD. The Subtalar MBA implant is a small threaded titanium
implant which is inserted into the subtalar joint. It is designed to block
excessive pronation of the subtalar joint to realign the foot, thus allowing
normal joint motion and lessening stress on the tendon. Bone procedures
may also be necessary to correct the deformity. These procedures provide
greater structural correction and stability to the foot.