Insertional Tibialis Posterior Tendonitis
What is Insertional Posterior Tibial Tendon Dysfunction (PTTD)
People with this problem generally are unable to stand on one leg and lift the heel off the ground and if the condition has been present for a while they commonly present with a flat foot. Typically pain is also present at the insertion on the navicular bone.
Ultrasound examination at The Foot and Ankle Centre can assist in diagnosing this problem.
Causes of Insertional Posterior Tibial Tendon Dysfunction (PTTD)
- Trauma – acute trauma to the tendon can result in its degeneration
- Accessory Navicular Bone – This extra bone can result in pain at the insertion of the tendon
- Certain Connective tissue disorders
- Biomechanical abnormalities- The main cause of Posterior TIbial Tendon Dysfunction is having an overly flat foot. This is because the position of the foot changes the demand from certain muscle groups.
Neutral Foot Flat Foot 
In a neutral foot (see above image) the muscles on the inside of the foot (invertors) work just as hard as the muscles on the outside of the foot (evertors). In a flat foot or a foot that is not supported (see above image) the muscles on the inside of the foot (invertors) work a lot harder to try and correct the position of the foot – overtime this can result the degeneration of the tibialis posterior tendon.
Complications of Insertional Posterior Tibial Tendon Dysfunction
- Pain
- Adult acquired flat foot deformity
- Midfoot arthritis
- Subtalar joint arthritis
- Ankle Arthritis
- Sinus Tarsi pain
Treatment of Insertional Posterior Tibial Tendon Dysfunction
Treatment of insertional posterior tibial tendon pain achieved by minimising the activity of the invertor muscles and tendons
- Orthotics with a rearfoot post –There are a number of different orthotic designs available for flat feet. Most orthotic designs are simply arch supports.
These are not ideal for the flat foot, often only irritating the arch of the foot. - Footwear modification
- Lace up ankle brace
- Arizona brace
- Ankle Foot Orthotic
- Surgery
The Foot and Ankle Centre’s Northcote Podiatrists can help you with all lower limb complaints, including complications of a flat foot. Make an appointment to get your foot and ankle pain under control.