Signs of Posterior Tibial Tendon Dysfunction

Your posterior tibial tendon plays an essential role in supporting your arch and keeping your foot flat on the ground when you walk, run, and perform many other activities. Inflammation, overstretching, and tearing of this tendon can lead to posterior tibial tendon dysfunction, which is commonly associated with pain at the inner ankle and flattening of the foot over time. It is important to pay attention to signs of dysfunction early on, so that proper treatment can be administered and long term damage can be prevented.

Early signs of posterior tibial tendon dysfunction

While pain along the inside of the ankle that gets worse with activities like walking, running, or standing for long periods of time is one of the most common symptoms, early posterior tibial tendon dysfunction can be subtle and easy to overlook. Pain at rest may be mild or nonexistent, with some patients only feeling increased fatigue or instability in the foot. As the tendon becomes weaker, you may notice that you are no longer able to stand on one foot or push off with your toes as easily as before. The arch of your foot may begin to lower, and your foot may roll inward as the condition progresses. Knee, hip, and lower back pain can develop as other joints in your body are forced to compensate for the alignment changes and increasing strain in your foot and ankle.

Structural changes to your foot

As posterior tibial tendon dysfunction progresses, the strength of the tendon is diminished and it can no longer support the arch effectively. In many cases, your heel may begin to tilt outward, while the front of the foot moves away from the body. In severe cases, the arch may appear to collapse as the foot rolls inward. When looking at the back of the foot, you may be able to see more toes on the affected side. Footwear that was previously comfortable may become difficult to wear, and you may notice that your shoes have excessive wear along the inside edge of the sole.

The role of the posterior tibial tendon

Posterior tibial tendon dysfunction is an injury that many people experience because the posterior tibial tendon is one of the most commonly used in the body. This tendon is located on the inner part of your ankle and foot. It not only helps support your arch but also keeps your ankle joint aligned and stable. It also allows your foot to become rigid in the push off phase of gait, turning your foot into a lever that helps you walk or run. When the posterior tibial tendon is working properly, it also regulates pronation of the foot. When your foot rolls inward too much, the tendon helps to slow the motion down. When the tendon is injured or dysfunctional, it is unable to properly control your foot motion, causing too much pressure on your ligaments, bones, and joints.

Who is at risk for posterior tibial tendon dysfunction?

Treating posterior tibial tendon dysfunction as soon as possible is especially important as this is a progressive condition. Damage to this tendon may occur with repeated stress, sudden increases in activity, prolonged periods of standing, or injury. Certain populations such as middle aged adults, athletes, obese individuals, and those with diabetes or inflammatory arthritis conditions are at an increased risk of posterior tibial tendon dysfunction. If you notice any of these warning signs, it is time to seek treatment before this condition becomes more serious and severe.

When to see a doctor

If inner ankle pain persists for longer than a few weeks, if swelling does not improve with rest, or if you notice that your foot is flattening out, it is time to see a doctor. Inability to perform a single leg heel raise or progressive difficulty with walking can also indicate posterior tibial tendon dysfunction and should prompt further investigation. Your doctor will conduct a thorough evaluation and imaging may be ordered to determine the extent of the problem.

Visit Treasure Valley Foot & Ankle for treatment and evaluation when the condition is still in the early stages, before pain begins to severely impact your daily activities. A correct diagnosis made early can help you create a treatment plan that will protect your tendon, support your foot, and minimize your need for surgery in the future.

Treatment for posterior tibial tendon dysfunction

Treatment for posterior tibial tendon dysfunction in the early stages is usually nonoperative, although those in moderate stages may require some sort of surgery to correct the issue. Activity modification, supportive footwear, custom orthotics, bracing, and a structured physical therapy program are all possible treatment options that may be considered by your healthcare provider. Surgery may be required in advanced cases with fixed deformity or arthritis.

Frequently Asked Questions

What are the first signs of posterior tibial tendon dysfunction?

The first signs are usually pain on the inside of the ankle, along with mild swelling. Arch fatigue and discomfort are also common and can get worse after physical activity or long periods of time on your feet.

How can I tell if my flatfoot is getting worse?

Progressive collapsing of the arch, outward tilting of the heel, increased wear on one side of the shoe, and issues with balance or pushing off can all indicate a worsening condition.

Is posterior tibial tendon dysfunction the same as plantar fasciitis?

Plantar fasciitis is heel pain, often most noticeable with the first few steps in the morning. Posterior tibial tendon dysfunction causes inner ankle pain and causes flattening of the foot over time.

Can posterior tibial tendon dysfunction heal on its own?

Posterior tibial tendon dysfunction rarely heals on its own and can progressively worsen over time if left untreated. Treatment in the early stages can help alleviate symptoms and prevent the condition from getting worse, but untreated cases rarely resolve on their own.

When should I see a foot and ankle specialist?

Persistent pain, swelling, and difficulty walking are all reasons to see a foot and ankle specialist. You should also seek evaluation if you have visible changes in the shape of your foot.