What is Posterior Tibial Tendonitis or PTTD? What Can I Do about It?

Posterior Tibial Tendonitis (PTT), also known as Posterior Tibial Tendon Dysfunction (PTTD), is a condition that goes by many names and can cause significant pain and limit mobility. It's a relatively common condition affecting 3-10% of the population. However, a lot of people who visit the in-person physical therapy practice of Luke, our co-founder, don't know they have it until they work with him, because Posterior Tibial Tendonitis is very much underdiagnosed.

Understanding this condition, its causes, risk factors, and symptoms can help you manage and treat it effectively, regardless of what you call it. Let's dive in, so you can leverage effective at-home PTTD treatments to take control of your recovery.

Another term, overpronation, is a more general term that describes the inward rolling of the foot when walking or running. Overpronation is a common symptom of posterior tibial tendon dysfunction. (As an independent condition, it's also a risk factor for Posterior Tibial Tendonitis.) This inward roll can exacerbate the condition and lead to further problems throughout the chain of movement, like knee pain, if not addressed.

The posterior tibial tendon is essential for maintaining the arch of the foot and providing shock absorption and stability when walking or running. This tendon runs along the inside of the ankle and helps with the push-off phase of the gait cycle.

However, when the posterior tibial tendon is injured or inflamed, its ability to support the arch diminishes. As a result, the arch can flatten or collapse, leading to decreased shock absorption and increased strain on other parts of the foot and ankle. This additional strain can cause pain and discomfort as the muscles and tendons work harder to compensate for the compromised posterior tibial tendon.

Several factors can contribute to the development of PTTD. If you think of the root cause as the load and capacity mismatch, the list should make sense. Common causes of Posterior Tibial Tendonitis include:

1. Increased Activity: Longer hours on your feet due to job change, or more frequent running to train for a race can overwork the tendon.
2. More Intense Activities: Pursuing high-impact sports or activities or increasing the intensity without proper conditioning can strain the tendon beyond its capacity.
3. New Activities: Sudden changes in your activity level, like walking hours on uneven surfaces during a vacation or picking up a fun new sport, can trigger PTTD.
4. Weight Gain: Increased body weight puts additional stress on the posterior tibial tendon, making it more susceptible to injury. Studies have found that a 25-lb weight loss (granted, this is no easy feat!) can relieve pain by 30% - imagine the impact if the scale was tipping the other way.

Understanding the risk factors can help you prevent and manage PTTD. You might be at higher risk if:

• You tend to walk on the inside of your feet: This gait pattern (overpronation) can strain the tendon. The telltale sign of overpronation is extra wear on the inside of your shoes.
• Your knees come together (Knock Knees): This alignment issue not only exacerbates overpronation but also increases the stress on the posterior tibial tendon.
• You have low or no arch: A naturally flat foot places more demand on the tendon to absorb the shock and stress.
• You are overweight or recently gained weight: Excess weight increases the load on your feet, especially if your weight gain didn't come with a corresponding increase in strength.
• You stand for long periods at work: Jobs that require prolonged standing, such as nursing, teaching, or factory work, can overburden the tendon.
•  Your activity levels increased or you took up a new activity recently: Sudden increases in physical activity can trigger PTTD.

Recognizing the symptoms of PTTD early is key to finding the right treatment and avoiding progression of the condition. If you are seeking a healthcare professional's help, it can be especially helpful, since this is a condition that your doctor or PT may overlook or misdiagnose.

Look out for these three telltale signs:

• Burning sensation or dull ache on the inside of your ankle: This pain usually occurs below the ankle but can extend above it. The discomfort may be persistent or come and go.
• Worsening pain after activity: The pain tends to get worse after being active for a while, especially after prolonged walking or standing.
• Increased discomfort when going uphill or up stairs: Activities that put more strain on the tendon through push-off movements, like climbing stairs or walking uphill, often exacerbate the PTTD pain.
• Swelling around the ankle: Inflammation associated with Posterior Tibial Tendonitis often causes fluid accumulation and swelling around the ankle. This restricts the smooth movement of the tendon, worsening the pain and further reducing function.

The gold standard of non-invasive, active treatment for Posterior Tibial Tendonitis incorporates four components that work together:

• Load management: Wear a brace to help maintain the arch and reduce the load that the injured tendon has to support
• Venous return: Wear compression socks to encourage fluid drainage and reduce ankle swelling
• Progressive strengthening: Gradually increase strength throughout the kinetic chain by following a program of eccentric strengthening exercises
• Soft tissue mobilization: Massage the small muscles and tendons that support the arch to reduce pain, release tension, and encourage the growth of healthy tissue

This is the basis of the Alleviate Method, developed to bring the effective treatment methodology and tools to everyone's home. Our PTTD System uses the Alleviate Method to get you back to doing what you love, without a visit to a doctor's office. Check it out, and let us know if we can answer any questions!