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Posterior Tibial Tendon Dysfunction (PTTD), also known as Adult Acquired Flat Foot, involves the progressive flattening of the foot, causing ankle and arch pain. It results from inflammation, tearing, or degeneration of the tibialis posterior tendon, which supports and lifts the arch. Individuals with PTTD may experience pain and swelling along the inner ankle and arch, difficulty standing on toes or balancing on one foot. If left untreated, PTTD can worsen, leading to severe flat foot deformity.
Causes and Risk Factors of PTTD
Overuse: Repeated stress on the tendon.
Injury: Direct trauma to the tendon.
Biomechanical Issues and Foot Structure: Abnormal foot mechanics can stress the tendon. Conditions like flat feet or excessive pronation increase the risk.
Obesity: Excess weight adds stress to the tendon.
Accessory Navicular: Individuals with an extra bone on the inner foot are more likely to develop PTTD due to increased traction on the tendon.
Diabetes: Can lead to tendon degeneration and increase the risk.
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Signs and Symptoms of PTTD
PTTD can progress due to the nature of the condition. It is classified into stages based on severity. If left untreated, a patient might develop ankle arthritis and a fixed deformity. Patient with PTTD may experience the following signs and symptoms:
Pain: Felt along the inside of the ankle and foot.
Swelling: Common around the medial side of the ankle.
Flatfoot Deformity: Gradual loss of the foot’s arch, which can be unilateral.
Difficulty Walking: Pain and structural changes can make walking challenging.
Loss of Strength and Balance: Difficulty standing on tip-toes and maintaining balance on the affected foot.
Treatment and Management of PTTD
Treatment and Management of PTTD
Treatment strategies vary based on the condition’s stage. Early intervention with a combination of conservative treatments can often prevent progression and avoid the need for surgery.
Rest and Ice: To reduce pain and inflammation.
Tendon Rehabilitation Exercises: To strengthen and rehabilitate the tendon.
Supportive Footwear: To provide adequate support and reduce stress on the foot.
Custom Foot Orthotics or Ankle-Foot Orthotics: To improve foot alignment, offload the affected structures, and provide support.
Shockwave Therapy: To promote tissue regeneration and provide symptomatic relief.
Surgery: Considered if conservative treatments are ineffective.
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