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From the American Academy of Orthopaedic Surgeons

Posterior Tibial Tendon Problems

by Stephen F. Conti, MD; Karl-Andre Lalonde, MD

Posterior tibial tendon dysfunction (PTTD) is an inflammation and/or overstretching of the posterior tibial tendon in the foot. An important function of the posterior tibial tendon is to help support the arch of the foot. In PTTD, the tendon's ability to perform that job is impaired, often resulting in a flattening of the foot. The exact cause of PTTD is unknown; however, several causes have been suggested, including mechanical overload and hypovascularity in the portion of the tendon distal to the medial malleolus. Nonsurgical treatment of disease stages 1 and 2 involves treatment with nonsteroidal anti-inflammatory drugs and supportive shoes. Stage 2 disease is addressed surgically with a flexor digitorum longus to posterior tibial tendon transfer with medializing calcaneal osteotomy and/or lateral column lengthening, with possible selective gastrocnemius lengthening; however, appropriate surgical treatment for stage 2 disease remains controversial.

Keywords: acquired adult flatfoot, posterior tibial tendon dysfunction, PTT dysfunction, posterior tibial tendon insufficiency, PTT insufficiency, PTTD, too-many-toes sign, mechanism of injury, etiology, classification, diagnosis, patient history, physical examination, imaging, radiography, differential diagnosis, management, nonsurgical treatment, surgical treatment, indications, contraindications, flexor digitorum longus transfer, medializing calcaneal osteotomy, lateral column lengthening, complications, rehabilitation

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