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Posterior Tibial Tendon Dysfunction - Acquired Flatfoot

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Posterior tibial tendon dysfunction, also known as acquired flatfoot, results when the tendon at the back of the ankle is inflamed or torn.  It is a progressive condition that can eventually lead to a fallen arch or flatfoot.  Advanced cases, or those that do not respond to non-surgical treatments, may require surgery.  There are various surgical procedures for posterior tibial tendon dysfunction, and it is common to need more than one.

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Introduction

Posterior tibial tendon dysfunction, also known as acquired flatfoot, results when the tendon at the back of the ankle is inflamed or torn.  It is a progressive condition that can eventually lead to a fallen arch or flatfoot.  Advanced cases, or those that do not respond to non-surgical treatments, may require surgery.  There are various surgical procedures for posterior tibial tendon dysfunction, and it is common to need more than one.
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Anatomy

The posterior tibial tendon connects at the calf, travels around the inside of the ankle joint, and attaches to the bones in the midfoot.  It maintains the arch in your foot and provides stability when you walk.
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Causes

Posterior tibial tendon dysfunction results when the tendon becomes inflamed or torn.  Sports injury and overuse can contribute to posterior tibial tendon dysfunction.  Certain medical conditions, such as obesity, hypertension, diabetes, and arthritis increase the risk of the condition.  Problems with this tendon are more common in women.
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Symptoms

Posterior tibial tendon dysfunction most frequently develops in one foot, but it can affect both feet.  Symptoms are usually progressive, meaning they get worse over time.  You may first notice pain, redness, and swelling along the inside of your ankle and foot.  As the arch in your foot flattens, you may experience pain in your outer and midfoot, weakness, and the inability to stand on your toes.

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Diagnosis

You should see your doctor if you suspect that you have posterior tibial tendon dysfunction.  Early diagnosis and treatment can help stop the progression of the condition.  Your doctor can diagnose posterior tibial tendon dysfunction by reviewing your medical history, examining you, and conducting some tests. 

Your doctor will ask you to stand or move your foot in certain ways so that it can determined how your tendon is functioning.  X-rays, ultrasound, or magnetic imaging resonance (MRI) imaging may be used to provide pictures of your ankle and leg structures.
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Treatment

In some cases, early non-surgical treatment can help prevent the need for surgical treatment in the future.  In the early stages, pain and swelling are treated with rest and aspirin or ibuprofen.  A short leg cast or boot may be worn while the tendon heals.  Physical therapy usually follows casting to help the ankle joint gain range of motion and strength.  You may be issued an ankle stirrup, custom orthotic device, or custom shoe insert to help support your foot. 
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Surgery

Surgery may be recommended when non-surgical treatments fail to provide symptom relief, or for advanced cases of posterior tibial tendon dysfunction.  There are several types of surgery, and you may need more than one type of procedure.  Surgery is used to removed inflamed tissue, improve the position of the heel bone, transfer another tendon for reconstruction, or fuse bones together to prevent movement and add stability. 
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Recovery

Following surgery, you may need to wear a protective splint, cast, or boot.  Physical rehabilitation exercises can help you regain strength and stability.  You may need to use a cane or crutches at first. 

Recovery is individualized.  The amount of time you need to heal depends on the extent of your condition and the procedures that you received.  Your doctor will let you know what to expect.
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Prevention

In some cases, early diagnosis and treatment can stop the progression of posterior tibial tendon dysfunction.  You should wear the arch supports, custom orthotic inserts, or orthotic shoes  recommended by your doctor.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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The multi-specialty medical team at North Country Orthopaedic Group provide treatment for a full spectrum of injuries and diseases that affect the musculoskeletal system. Our areas of expertise include general orthopedics, pediatric orthopedics, sports medicine, total joint replacement surgery, a spine program, foot and ankle care, physical medicine & rehab, physical therapy, radiology, and endocrinology. In addition, North Country Orthopaedic Group performs many surgeries and interventional procedures in our ambulatory surgical center in Watertown, NY.