Posterior Tibial Tendon Dysfunction Grade II

Posterior tibial tendon dysfunction (PTTD) is one of the most common causes of an adult-acquired flatfoot. The posterior tibial tendon runs along the inside of the ankle and supports the arch; when it becomes inflamed, frays, or tears, the arch gradually collapses and the foot rolls inward. Our own Dr. Ramy Fahim discusses treatment for Grade II of this condition below.

The Four Stages of PTTD

• Grade I: tendonitis — pain and swelling along the inside of the ankle, arch still intact
• Grade II: tendonitis with tearing — the tendon is failing and a flexible flatfoot begins to develop
• Grade III: a rigid (fixed) adult-acquired flatfoot
• Grade IV: a rigid flatfoot with the ankle joint also affected

Symptoms to Watch For

• Pain and swelling along the inner ankle and arch
• A flattening arch, or “too many toes” visible from behind
• Difficulty standing on tiptoe on the affected side
• Pain that shifts to the outside of the ankle as the deformity progresses

Treating Grade II Disease

There are many ways to treat PTTD depending on its stage — from supportive measures to reconstructive surgery. Early grades often respond to custom orthotics or bracing, immobilization, anti-inflammatory care, and physical therapy. When a Grade II tendon has torn and conservative care fails, surgery typically combines a tendon repair or transfer with bone procedures (osteotomies) that realign the foot and rebuild the arch — joint-preserving when possible.

Fusions (arthrodesis) join two or more bones together — “set it and forget it.” They are generally reserved for more advanced disease, Grade III or IV, or for a heavier patient with Grade II disease where a joint-sparing repair is less likely to hold. The videos below show procedures ranging from a single arthrodesis to a triple arthrodesis.

Catching PTTD early — in Grade I or II — gives the best chance of avoiding a major reconstruction, so inner-ankle pain and a flattening arch should be evaluated promptly.

For more information or to schedule an evaluation with a board-certified foot and ankle specialist, call (239) 430-3668 (FOOT) or book online at NaplesPodiatrist.com.

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Serving Southwest Florida since 2005, Family Foot & Leg Center has 9 convenient locations throughout Collier, Lee, Charlotte, and Sarasota Counties — Naples, Estero, Fort Myers, Cape Coral, Port Charlotte, and Sarasota. We provide pediatric to geriatric foot and ankle care: ingrown toenails, heel pain, bunions, foot & ankle arthritis, plantar fasciitis, foot & ankle surgery, custom orthotics, and diabetic wound care — with in-office X-rays, diagnostic ultrasound, and minor surgical suites. Home of the Lam Minimally Invasive No-Scar Bunion Surgery. Same-day appointments and easy online scheduling.