Posterior Tibial Tendon Dysfunction Treatment in Los Angeles

What Is Posterior Tibial Tendon Dysfunction (PTTD)?

The posterior tibial tendon plays a crucial role in foot alignment and supporting the arch of the foot. Posterior tibial tendon dysfunction (PTTD) occurs when the tendon weakens or degenerates, causing the arch to collapse over time. PTTD is commonly referred to as adult-acquired flatfoot because it is a leading cause of flatfoot in adults. While it often affects only one foot, it can develop in both. Without treatment, PTTD is progressive and worsens over time.

The podiatry experts at Foot and Ankle Specialty Group, led by Dr. Soomekh, the best foot and ankle doctor in Los Angeles, are here to help you relieve discomfort from PTTD at our state-of-the-art facility in Beverly Hills.

How Is PTTD Related to Flat Feet?

“Flat feet” is a term used to describe the reduced height of the inner arch compared to a normal arch. The degree of arch flattening varies among individuals. Some people have flexible flat feet, where the arch can be manipulated, while others have rigid flat feet that do not change shape. Not everyone with flat feet experiences pain or difficulty with activity. A child with flat feet will not necessarily develop problems in the future, and not all flat feet require treatment.

What Is Pronation?

Pronation refers to the natural movement of the foot as it shifts from a higher to a lower arch while walking. This movement is normal, but excessive motion, known as overpronation, can cause foot fatigue and lead to pain in the ankles, knees, and hips. Overpronation is a common issue in individuals with flat feet and can contribute to instability and discomfort.

Key anatomical structures affecting arch height and function include:

• Subtalar Joint: Connects the ankle bone and the heel bone
• Talo-Navicular Joint: Connects the ankle bone to the inside foot bone
• Calcaneocuboid Joint: Connects the heel bone to the outside foot bone
• Posterior Tibial Tendon: A key tendon that supports the arch and maintains foot function

Causes of Posterior Tibial Tendon Dysfunction

The primary cause of posterior tibial tendon dysfunction (PTTD) is overuse, often resulting from repetitive activities that place strain on the tendon. Certain anatomical factors can also increase the risk of developing this condition. Common causes include:

• Repetitive activities such as running, walking, hiking, or climbing stairs
• Naturally low arches, which put added stress on the tendon
• Presence of an Accessory Navicular Bone, making the tendon more prone to damage and pain

PTTD can develop in two ways:

1. A normal arch becomes flat over time due to tendon damage and stretching.
2. A naturally flat foot leads to excessive tendon strain, which worsens dysfunction.

Signs and Symptoms of Posterior Tibial Tendon Dysfunction

Symptoms of PTTD progress in stages and worsen over time:

• Early Stage: Pain along the inside of the foot, redness, swelling, and warmth
• Progression: Worsening pain, flattening of the arch, outward turning of the foot, and inward rolling of the ankle
• Advanced Stage: Severe arch collapse, pain shifting to the outer foot, tendon tearing, and arthritis in the foot and ankle

Diagnosing Posterior Tibial Tendon Dysfunction

A thorough clinical examination is essential for diagnosing PTTD. Dr. David J. Soomekh, the best podiatrist in Los Angeles, carefully assesses your symptoms, gait, and foot structure. Diagnostic tools include:

• Digital X-rays: Assess bone positioning and severity of deformities
• CT Scans: Provide a 3D view of bone alignment for detailed analysis
• MRI Scans: Evaluate the extent of tendon damage

request appointment

Treatment Options for Posterior Tibial Tendon Dysfunction

Conservative Treatment for PTTD

Early diagnosis and intervention are crucial to preventing severe complications. Dr. Soomekh recommends a strict two- to four-week initial therapy protocol, which may include:

• Anti-Inflammatory Medications (NSAIDs): Reduce pain and swelling
• Ice Therapy & Rest: Minimize strain on the tendon
• Walking Boot: Restricts movement to allow healing
• Physical Therapy: Strengthens the tendon, improves mobility and stabilizes the foot

Custom Molded Orthotics

Custom orthotics provide essential arch support and reduce strain on the posterior tibial tendon. They help control excessive motion and prevent further tendon damage, offering long-term relief and stability.

Cortisone (Steroid) Injections

Dr. Soomekh does not recommend cortisone injections for PTTD, as steroids can weaken the tendon and worsen the condition.

Treating Chronic Posterior Tibial Tendinosis

If left untreated, PTTD can become a chronic condition (tendinosis), where the body stops actively healing the damaged tendon. Dr. Soomekh offers advanced treatments to stimulate healing and restore function.

Minimally Invasive Procedures for PTTD

• Platelet-Rich Plasma (PRP) Therapy: Uses the patient’s own platelets to promote healing
• Topaz Coblation Therapy: Stimulates the tendon by creating small perforations that trigger repair.
• Tenex™ Percutaneous Tenotomy: Removes damaged tendon tissue through a tiny incision under ultrasound guidance, minimizing downtime, and supporting faster recovery.

Surgical Treatment for Posterior Tibial Tendon Dysfunction