The posterior tibial tendon is a cable-like bundling of flexible tissue located in the posterior or back of the leg responsible for connecting the calf muscles to the bones in the middle of the foot by wrapping through the ankle. This tendon helps provide support to the arch of the foot and stabilizes the foot as it pushes off from the toes to swing the leg forward when walking. Posterior tibial tendon dysfunction, also referred to as PTTD, is when there is inflammation resulting in swelling, tenderness and pain of this important tendon. It is also possible to experience difficulties with walking or foot movements when this area is inflamed.
Injuries, overuse syndromes or certain medical disorders such as degenerative joint disease, also known arthritis, can cause inflammation — the body’s protective response — which can irritate the tendon in the calf area, resulting in posterior tibial tendon dysfunction. In addition to tenderness of the tendon and pain with movement, this condition can cause a flattening of the arch of the foot and an inward rolling of the ankle. If left untreated, the problems associated with posterior tibial tendon dysfunction will usually get progressively worse. Over time, the joint or connection between the bones and the muscle will begin to deteriorate and cause a permanent change to the structure of the foot.
The most important treatment protocol of posterior tibial tendon dysfunction is prevention. Since common activities, such as walking, running or step climbing — especially when this tendon is not properly stretched and conditioned — can cause or prolong symptoms, it is important to comply with a regular stretching and exercise program to maintain optimal posterior tibial tendon length and strength. If posterior tibial tendon dysfunction occurs, a stopping the aggravating movements or activities temporarily is advised to allow the tendon to heal.
Once the initial pain and swelling from posterior tibial tendon dysfunction has dissipated, a slow return to activities, starting with improving flexibility of the tendon through range of motion exercises and stretching, should help avoid future injury. Strengthening of the surrounding areas, including the calf and shin musculature, will provide support to the posterior tibial tendon and will also aid in preventing irritation of the area. Specific activity-related movement strengthening should be added to assure this tendon has the ability to handle intense movements that may be required to perform at an optimal athletic level. To assure proper healing and rehabilitation, a treatment protocol directed by a physical therapist may be necessary for a few weeks following an injury to the posterior tibial tendon.