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Posterior Tibial Tendon Dysfunction
(Flat Foot)


The posterior tibial tendon is a tendon on the inside of the ankle that provides stability and support for the arch of the foot. Pain can occur when the posterior tibial tendon becomes inflamed or torn. This may result in a flatfoot.

Causes & Symptoms

Posterior tibial tendon dysfunction occurs in those with obesity, diabetes, and hypertension. It is most commonly seen in women and in people older than 40 years of age. In the setting of an acute injury or chronic over use, the tendon can become inflamed.

Symptoms of posterior tibial tendon dysfunction include pain and swelling along the inside of the foot and ankle and pain that is worse with activity.

Evaluation & Treatment

Initial evaluation includes a detailed history, examination maneuvers, and X-rays. An MRI or ultrasound may be ordered to evaluate for a tendon tear or extent of tendonitis.

Treatment begins with rest, ice, anti-inflammatory medications, immobilization, orthotics, braces, and physical therapy. Pain resolves slowly even with treatment and may last 3-6 months with treatment and sometimes longer if symptoms have been for many months prior to treatment.

Surgery should be considered if pain does not improve despite 6 months of appropriate treatment.. Surgical treatment may be done as an outpatient or overnight procedure. Reduction in pain may take 12 months or longer.