Overuse injuries are common in runners and athletes, with a majority of injuries affecting the lower legs. One of these progressive injuries is called posterior tibial tendon dysfunction, or PTTD. If you noticed ankle/foot pain with activity, your foot is starting to appear flat, and your ankle rolls inward, PTTD might be the culprit. PTTD is commonly referred to as adult acquired flat foot, as it is the most commonly occurring form of flat-footedness in middle-aged to senior adults.
PTTD is common in runners, specifically those who already have a low arch. PTTD involves the tendon that supports the inside structures of your foot. The posterior tibial tendon runs behind the bony bump on the inside of your ankle and attaches to the middle bottom of your foot. This tendon supports the central arch of your foot, especially during walking and running. When there is too much stress on this tendon, it becomes irritated and starts to break down, causing increasing pain levels on the inside of your foot. Repetitive activity and overuse can cause the tendon to become inflamed, enlarged, and thickened. The arch of your foot may start to appear flatter since it no longer has as much support as it needs. Pain and swelling can occur on the inside of your foot. Standing on your toes can be very difficult.
Additional factors that can increase the risk of developing PTTD and having pain on the inside of your foot include poor-fitting shoes, changes in the structure of your feet, age, obesity, or increased activity such as walking or running. Increased stress on the tendon and the resulting pain on the inside of your foot can also be caused by weakness in the thigh, hip, or calf muscles, making the muscle attached to the tendon work even harder as it attempts to compensate for the frailty in the aforementioned areas.
What Are the Symptoms of PTTD?
- Pain or swelling at the inside of your foot
- Arch of your foot appears flatter
- Ankle begins to roll inward
- Difficulty walking, running, hopping, or jumping
- Difficulty standing on your toes
- Decreased balance
- Weakness around the ankle/foot, especially when trying to bring your foot down and inward.
- Stiffness in your foot, especially in the morning
- Foot that starts to point out towards the side in standing
What Are the Stages of PTTD?
Stage I: Mild swelling. Pain on the inside of the ankle. Able to stand on toes but painful.
Stage II: Arch of your foot starts to flatten progressively. Foot begins to turn outward — less pain and swelling.
Stage III: Similar to Stage II but increased pain. May also have pain on the outside of your foot.
How Is PTTD Diagnosed?
Your physical therapist will look at your feet, as well as your knees and hips, to try and identify the root of the cause. Your therapist may also ask questions about your health history, your activities and watch how you walk. In some cases, an MRI or ultrasound may be performed to confirm the diagnosis or rule out other causes. As with a majority of injuries, early diagnosis will result in a better outcome.
How Can Physical Therapy Help When the Inside of My Foot Hurts Due to PTTD?
After evaluating the strength and motion of your lower leg, your foot physical therapist will develop an exercise program to address any weaknesses or deficits they find.
Strengthening: Your therapist will prescribe exercises that target the lower leg and intrinsic foot muscles. These will help increase support and decrease stress around your foot and ankle.
Stretching: Your therapist will show you how to properly stretch the muscles around your lower leg to prevent further irritation of the tendon and increase proper foot motion.
Hands-On Therapy: Manual therapy, such as joint and soft tissue mobilization, can help increase healing, reduce pain, and improve mobility. This will complement your exercise program well and lead to proper recovery of normal foot motion.
Orthotics: Your therapist may recommend orthotics to place in your shoe in order to increase support at the arches of your foot. Your therapist may also recommend proper footwear for your foot type, further decreasing stress to the foot and ankle.
Initially, applying ice, elevating the foot, and resting the foot may help calm down early symptoms of PTTD, but it does not address the leading cause of the problem. Having your physical therapist evaluate how you move and find those weak areas that are causing added stress to your foot and ankle will identify the origin of your symptoms. Then, a permanent solution can be identified.
Will I Need Surgery for the Pain on the Inside of My Foot?
In some cases, if non-surgical treatment options have failed to relieve the pain on the inside of your foot due to PTTD, surgery may be the only option. A podiatrist will determine if surgery can help when other methods have not and consult with a foot and ankle surgeon to proceed with surgical treatment. As previously mentioned, early detection of PTTD when the inside of your foot is hurting is crucial to a better outcome with non-surgical methods of treatment.
Overcoming the Pain Caused by PTTD With the Help of Total Performance Physical Therapy
At Total Performance Physical Therapy, we take a multi-dimensional approach to fighting foot pain caused by PTTD. Our knowledgeable physical therapists will develop a hands-on and highly-individualized strategy to reduce the foot pain you are experiencing and develop long-term solutions to prevent its reemergence. You will be educated on PTTD and what activities can be performed to reduce the pain on the inside of your foot and regain control over your freedom and mobility. We know that every one of our patients is more powerful than the pain they experience and will teach you how to overcome the pain caused by PTTD and other medical conditions. With our specialists at your side, each step you take will be one in the right direction, pain management without the need for surgery, medications, or invasive injections.
For more information on physical therapy for foot and ankle pain, reach out to our team today!
