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You could have pain and swelling along the inner side of the arch of the foot, ankle and along the course of the tendon. At first, these symptoms are only present with exercise and extended periods of standing or walking. With rest, the pain and swelling will subside. As the tendon's inflammation worsens, the pain will not subside, even with extended periods of rest. The pain and swelling are almost always present in the later stages of this disease.
The Medial Longitudinal Arch will start to fall. This will cause the foot to become flat. In the later stages of this condition, the arch collapses completely. When this occurs, the entire foot begins to ache and will feel weak, making it difficult and uncomfortable to be on your feet.
You will have an inability to resist pronation forces. When the tendon is inflamed and painful, it cannot function properly. One of its primary functions is pulling on the arch's inner side and preventing the foot from rolling in (pronation). When it is inflamed, it cannot do this, so the foot begins to roll inwards or pronate. In later stages, it will appear that the foot is entirely collapsed, and when you walk, you are only applying pressure to the inner part of the ankle and arch rather than the entire foot. This will eventually cause heel pain, ankle pain, shin splints, knee and hip pain, and lower back pain.
You will be unable to raise up onto your tiptoes without pain. The Posterior Tibial Tendon stabilises the arch and foot, especially when we try to stand on our toes. When this tendon is inflamed, it has difficulty stabilising the foot, so it must work harder to do so. This extra exertion on the tendon's part will cause it to become painful when trying to stand on one's toes.
Injury is the most common cause of Posterior Tibial Tendon Dysfunction. This can occur in the following ways:
Injury - Direct injury to the tendon, such as a blow to the tendon, or a fall resulting in a sprain, usually attained during sports.
Micro-trauma - An example would be an overuse injury due to excessive repetitive movements (always running in the same direction on a track with a pitch).
Age - The tendons lose their elasticity and ability to glide as smoothly as they used to. Thus, older individuals are more prone to developing tendonitis symptoms due to the tendon's impaired gliding motion. When the tendon no longer functions as it should, it becomes swollen, inflamed, and painful. (The cause of these age-related changes is thought to be due to changes in the blood vessels that supply nutrition to the tendons).
Having excess weight - Overweight individuals place abnormal amounts of weight on the arch, forcing it to eventually collapse, no matter how hard the Posterior Tibial Tendon tries to prevent this collapse. As this tendon overworks, trying to maintain the arch height, it eventually becomes inflamed, swollen, and painful. The end results are Tears within the tendon, a wholly collapsed arch or a pronated and unstable foot.
Hereditary Defects - Certain hereditary defects can make us more prone to various forms of tendinitis and Posterior Tibial Tendonitis/ Dysfunction for example:
Flat feet place excessive loads or pull on the Posterior Tibial Tendon. As the foot flattens, it stretches this tendon. The tendon, in the meantime, is over-working because it is trying to prevent the arch from collapsing further. This stretching or thinning of the tendon, along with its over-exertion, will produce inflammation and pain in the tendon. If the arch is not adequately supported, small tears will eventually appear in the Tendon, causing almost constant pain in the tendon.
Pronation is the force that causes the foot to flatten at the arch, causing one to walk more on the inner border of the foot than is usual. There are mechanical reasons for pronatory forces causing the foot collapse. This constant failure of the tendon to prevent pronation causes the tendon to overwork. This will eventually result in swelling, inflammation, pain, tearing of the tendon, and instability of the entire foot.
An Accessory Navicular Sesamoid (Bone) is a small loose bone that some people are born with. When it is present, it lies in front of the area where the Posterior Tibial Tendon would typically attach to the Navicular Bone. So, instead of connecting to the normal Navicular, the tendon attaches to the Accessory Navicular Bone. This prevents the tendon from pulling on the true Navicular and maintaining the arch height and normal foot position. Pain, swelling, and tendon tears occur due to the tendon over-working and trying to accomplish its functions.
An assessment with a podiatrist at the Footfix clinic in Birmingham should be sought to review the cause of your PTTD tendonitis and a management plan devised to treat the condition. Your running and exercise regime may require modifying, as may footwear to prevent excess pressure being placed on your foot.
‘Running through’ pain should be avoided. Continuing with the current, possibly harmful training regime that is causing the symptoms is likely to cause further damage and should be avoided. PTTD tendonitis should definitely not be ignored, just like any other foot pain you could be experiencing.
The worst-case scenario is that the tendon snaps. This is also known as a complete rupture of the Posterior Tibial tendon. It can occur all of a sudden if vigorous exercise is attempted out of the blue, or it can occur after a long period of tendonitis. A completely ruptured posterior tendon will require surgical attention.
An orthotic shoe insert that reduces the amount of pronation will typically be one of the best forms of treatment to prevent tendonitis however each patient is different. We would first assess the cause of your problem and then work with you to create the best treatment plan. Your podiatrist can also offer advice on footwear that you could use when training and exercising.
Radial Shock Wave Therapy may be initiated if you have a chronic condition that requires more intense treatment to get the tendon to heal, along with orthotics to control the pronation forces.
Ultrasound therapy can be initiated in the acute stages, rest ice compression, and immobilisation; this is known as the rice method. Once through the acute stages, treating the cause with orthotics will be required.
Injection of cortisone may be administered to the acutely inflamed tendon to reduce pain and swelling.
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