Posterior Tibial Tendon Dysfunction Treatment in Los Angeles
Pain and swelling along the tendon on the inside of the ankle, or an arch that is starting to collapse, is posterior tibial tendon dysfunction. Dr. Alexis Dixon, MD, FAAOS, a board-certified orthopaedic foot & ankle surgeon in Marina del Rey, diagnoses posterior tibial tendon dysfunction and treats it in the order the condition calls for.
Foot & Ankle Conditions
What Is Posterior Tibial Tendon Dysfunction?
Posterior tibial tendon dysfunction is a family of conditions that begin with the tendon on the inside, or medial, portion of the ankle. Mild cases may be notable only for pain and swelling along the tendon, but more severe cases lead to collapse of the arch of the foot and difficulty rising to a tiptoe position.
The posterior tibial tendon is the major inverter of the foot, which assists with side-to-side motion of the foot. When it is weak or injured, balance can become difficult, especially when walking on banked or uneven surfaces.
Get an Accurate Diagnosis
Diagnosis
The first step in diagnosis is appropriate imaging, meaning weight-bearing x-rays of the foot and ankle, and a thorough physical examination. Specific x-rays are taken in Dr. Dixon’s office to ensure the highest quality of x-rays, because not all x-rays are the same. If there is suspicion for a tear of the posterior tibial tendon, an MRI will be ordered.
Symptoms
Mild cases may be notable only for pain and swelling along the tendon, but more severe cases lead to collapse of the arch of the foot and difficulty rising to a tiptoe position:
- Pain and swelling along the tendon on the inside of the ankle
- Difficulty rising to a tiptoe position
- Difficulty with balance, especially when walking on banked or uneven surfaces
- Collapse of the arch of the foot in more severe cases
What Causes It?
Risk factors for this condition include overuse, cutting sports such as basketball, tennis, or soccer, obesity, diabetes, hypertension, prior trauma or surgery, inflammatory arthritis, and pre-existing flat feet.
Conservative First, Surgical When Needed
Treatment Options
Dr. Dixon works through the nonsurgical options in order before considering surgery. Many people improve significantly with physical therapy and go on to never need surgery.
Nonsurgical
Immobilization
If the pain is so severe that walking is difficult, a short use of a CAM boot or walking cast to fully immobilize the foot and ankle may be necessary.
Orthotics
Orthotics work by offloading the medial ankle with arch support, which can be helpful over time.
Anti-inflammatories
NSAIDs should be taken around the clock for two to three weeks at anti-inflammatory dosing. Speak with your physician if you have concerns about whether anti-inflammatories are safe for you.
Ice
Only use ice if you have no numbness in your feet. If you have any neuropathy, ice application may not be safe. Set the ice pack on the floor, place a dry washcloth on top, then set your foot on the ice pack. Rest or wrap the ice pack depending on where the pain is. Ice for up to twenty minutes at a time, and wait an hour before repeating.
Physical therapy
Physical therapy is not expected to change the shape of the foot or to repair tears. It works to improve strength and balance, and stretch the muscles that tighten over time due to the injury. It can also facilitate the decrease of inflammation. Many people improve significantly with physical therapy and go on to never need surgery.
Surgery
Surgery for severe posterior tibial tendon dysfunction addresses both the inflammation and the damage to the tendon. That means removing the tendon and borrowing the tendon to the toes in its place, and addressing the flat foot, which requires bony cuts to reshape and reconstruct the arch. Sometimes the soft tissues are insufficient, and fusion of three joints of the hindfoot is required to prevent any motion.
What NOT to Do
Do not immediately get injections or surgery for posterior tibial tendon dysfunction. Injections should be avoided altogether to prevent rupture of the posterior tibial tendon, which cannot be repaired once ruptured. Oral steroids are not recommended as a first-line treatment for posterior tibial tendon dysfunction because of the systemic risks, and there are more specific treatment options in most cases.
Seek attention from a specialist if you are concerned that the pain is worsening, or if it is not responsive to these treatments. Other sources of ankle pain should be ruled out.
Why Choose a Physician
Why See a Board-Certified Orthopaedic Surgeon (MD)?
Injections should be avoided altogether for posterior tibial tendon dysfunction, to prevent rupture of the posterior tibial tendon, which cannot be repaired once ruptured. Other sources of ankle pain should be ruled out first.
Dr. Dixon is a board-certified orthopaedic foot & ankle surgeon, not a podiatrist. Foot and ankle orthopaedic surgeons complete medical school, five years of residency training in orthopaedic surgery, and a yearlong advanced fellowship focused on foot and ankle care. They are the only healthcare providers with the depth and breadth of experience to treat the gamut of foot and ankle conditions, and it is highly recommended to always consult with a foot and ankle orthopaedic surgeon before planning surgery in the region.
After Treatment
What Recovery Looks Like
Nonsurgical treatment follows Dr. Dixon’s order: rest and immobilization, ice, oral anti-inflammatories, orthotics, and physical therapy. NSAIDs are dosed around the clock for two to three weeks. A CAM boot or walking cast is used only for a short period, when walking is too painful. Many people improve significantly with physical therapy and go on to never need surgery.
If surgery is required, it can involve removing the tendon and borrowing the tendon to the toes in its place, bony cuts to reshape and reconstruct the arch, and sometimes a fusion of three joints of the hindfoot.
Recovery after reconstruction depends on which of these procedures are done. Dr. Dixon reviews the expected timeline with you before surgery.
What Patients Say
Patient Reviews
Patient Questions
PTTD FAQs
About Your Surgeon
Alexis E. Dixon, MD, FAAOS
Dr. Dixon is a board-certified orthopaedic foot & ankle surgeon practicing in Marina Del Rey, California. USC-trained and named an LA Magazine Top Doctor since 2017, she combines surgical expertise with a conservative-first philosophy, treating the underlying joint and tendon, not just the symptom. She treats ganglion cysts, bunions, Achilles injuries, plantar fasciitis, fractures, and the full range of foot and ankle conditions.
Meet Dr. Dixon →Living With Inner Ankle Pain or a Collapsing Arch? Get a Real Diagnosis.
Get an accurate diagnosis and a clear plan from a board-certified orthopaedic foot & ankle surgeon in Marina del Rey.
Sources
References
The patient handout for this condition draws on the following sources.