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Posterior Tibial Tendon Dysfunction (PTTD) /
Adult Acquired Flatfoot
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What is Posterior Tibial Tendon Dysfunction?

When the Posterior Tibial Tendon becomes irritated from overuse, the gliding motion of the tendon
becomes impaired, thus leading to Posterior Tibial Tendon Dysfunction (PTTD). PTTD may be a slow
or abrupt progression resulting in inflammation, overstretching, partial, or complete rupture of the
tendon (1).


The Posterior Tibial Tendon begins in the calf, runs along the medial aspect of the foot, and inserts into
the navicular bone and lesser tarsus (ie. metatarsal bases, cuneiform, and cuboid) (2,3). The Posterior Tibial Tendon not only stabilizes the medial arch of the foot, it also plantar-flexes the foot which provides support during the toe-off phase of gait (1,2,3). Symptoms of PTTD may include pain, inflammation, an inward rolling of the ankle, and hindfoot valgus with forefoot abduction (a flattening of the medial arch of the foot) (1,2,3,4).

Posterior Tibial Tendon Dysfunction is the leading contributor of Adult Acquired Flatfoot (Pes Planus) (1,2,3,4,5). Additional contributing factors to the onset of PTTD may include hypertension, diabetes, peripheral neuropathy, smoking, or arthritis. The demographic most associated with Posterior Tibial Tendon Dysfunction and Adult Acquired Flatfoot are women over 50 and athletes, who present with an aggravated Posterior Tibial Tendon.

A common test to evaluate Posterior Tibial Tendon Dysfunction is the “too many toes sign.” The “too many toes sign” measures abduction (deviation away from the midline of the body) of the forefoot. With damage to the Posterior Tibial Tendon, the forefoot will abduct or move out in relation to the rest of the foot. When the foot is viewed from behind in cases of PTTD, the toes appear as too many on the outside of the foot, also known as hindfoot valgus with forefoot abduction.

Several classifications have been developed to describe and treat Posterior Tibial Tendon Dysfunction (3,5). Treatment of PTTD is determined based upon the clinical stage and health of the patient (5). If PTTD is diagnosed and treated early, non-surgical methods may be applied, such as biomechanical orthotics or heel elevators, medications, and/or casting (1). Such shoe gear will decrease the functioning load of the Posterior Tibial Tendon by supporting the arch of the foot and stabilizing the hindfoot.

In cases where Posterior Tibial Tendon Dysfunction has significantly progressed, or in circumstances where non-surgical applications have failed, surgical treatment may be required to correct the damage to the Posterior Tibial Tendon. Integra LifeSciences Corporation offers innovative and comprehensive products, designed for the surgical procedures associated with the treatment of Posterior Tibial Tendon Dysfunction and Adult Acquired Flatfoot.

*For product full prescribing information, see package insert.

References:

1. Kelly, Ian P, Mark E. Easly, TREATMENT OF STAGE 3 ADULT ACQUIRED FLATFOOT Foot and Ankle, Clin. Mar 2001: 153-166.

2. DiPaola M, Raikin SM, TENDON TRANSFERS AND REALIGNMENT OSTEOTOMIES FOR TREATMENT OF STAGE II POSTERIOR TIBIAL TENDON DYSFUNCTION, Foot Ankle Clin. 2007 June; 12(2): 273-85, vi.

3. Pomeroy GC, Pike RH, Beals TC, Manoli A 2nd., ACQUIRED FLATFOOT IN ADULTS DUE TO DYSFUNCTION OF THE POSTERIOR TIBIAL TENDO,N J Bone Joint Surg Am. 1999 Aug; 81(8):1173-82.

4. Mann RA, Thompson FM, RUPTURE OF THE POSTERIOR TIBIAL TENDON CAUSING FLAT FOOT. SURGICAL TREATMENT, J Bone Joint Surg Am. 1985 Apr; 67(4): 556-61.

5. Bluman EM, Title CI, Myerson MS, POSTERIOR TIBIAL TENDON RUPTURE: A REFINED CLASSIFICATION SYSTEM, Foot Ankle Clin. 2007 June; 12(2):233-49,v.

6. Wacker JT, Hennessy MS, Saxby TS, CALCANEAL OSTEOTOMY AND TRANSFER OF THE TENDON OF FLEXOR DIGITORUM LONGUS FOR STAGE II DYSFUNCTION OF TIBIALIS POSTERIOR. THREE TO FIVE YEAR RESULTS, J Bone Joint Surg Br. 2002 Jan; 84(1):54-8.


 
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