Posterior tibial tendon dysfunction

Transcription

1 Posterior tibial tendon dysfunction Information for patients MSK Outpatients (Therapy) PROUD TO MAKE A DIFFERENCE SHEFFIELD TEACHING HOSPITAL NHS FOUNDATION TRUST

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3 What is posterior tibial tendon dysfunction? Posterior tibial tendon dysfunction is a common problem affecting the foot and ankle. The condition occurs when the posterior tibial tendon becomes inflamed, worn or torn. This means that the tendon cannot fully support the ankle or the arch along the inside of the foot. Over time the arch along the inside of the foot can become flatter. This is often called a flat foot deformity. This condition is usually accompanied by pain and swelling which can make standing and walking very uncomfortable. The condition is usually progressive, which means it may become worse if it is not treated. Normal Arch Flatfoot Deformity page 3 of 8

4 How does the posterior tibial tendon work? The posterior tibial tendon arises from one of the muscles in the back of the calf (the tibialis posterior muscle). The tendon runs along the inner side of the ankle and it attaches to the inner border and sole of the foot. This muscle tendon helps to support the arch along the inside of the foot. Posterior tibial tendon Achilles tendon What causes posterior tibial tendon dysfunction? The most common cause is when the tendon gets inflamed or shows signs of wear after repetitive use or due to heavy repetitive loading. This may be the result of being overweight, undertaking high impact sports, long distance running or even a job that involves prolonged episodes of standing. The tendon can also get damaged during an acute injury such as a fall. Once the tendon gets damaged it is unable to fully support the arch along the inside of the foot. This means the arch can slowly collapse and the foot will become flatter over time. page 4 of 8

5 Who gets posterior tibial tendon dysfunction? Anyone can get posterior tibial tendon dysfunction but it seems to be more common in women, in people over 40 years of age and more common in people who have diabetes or those who are overweight. What are the signs and symptoms? Pain along the inside of the foot where the tendon lies. Swelling in the area where the tendon lies. The pain and swelling may increase with high intensity or high impact activities e.g. walking, running, prolonged standing. The foot may appear to have changed shape over time and look flatter and bigger. You may also experience pain on the outside of the ankle as the foot becomes flatter and its resting position changes. It may feel like your ankle has rolled inwards. The foot and ankle may feel weak and as though there is a loss of strength to push off from the ground whilst walking. How is posterior tibial tendon dysfunction diagnosed? Your health professional (physiotherapist or podiatrist) will listen to you describing the symptoms that you get and look at the shape of your foot. Your foot will be examined and you will be asked to perform movements to help with the diagnosis. This may include looking at how you walk or standing on your tip toes. Your health care professional will also feel the tendon for any areas of tenderness, pain or swelling. page 5 of 8

6 Treatment for posterior tibial tendon dysfunction Physiotherapy In the early stages of posterior tibial tendon dysfunction the symptoms may be eased with physiotherapy. You may be referred to a physiotherapist who can show you the best way to exercise the tendon to help make it stronger so that it supports the arch of the foot. The goal of this treatment is to help the tendon function better and so alleviate some of your pain. This will hopefully mean you can walk better and for longer. Your physiotherapist will provide you with separate information about the exercises. Orthotics You may also be referred to a podiatrist or orthotist who can provide you with insoles to help keep the foot in a better position or you may be issued with a brace to provide extra support. You may even be asked to wear a protective boot to allow the foot to rest completely for a period of time. It may take some time to get used to wearing an insole in your shoe or to get used to wearing a brace. It is important that you persevere with this and gradually build up your tolerance to wearing the insole or brace. It is important that you wear supportive shoes to help keep your foot and ankle in the best position. Your podiatrist or orthotist will discuss this with you and suggest what footwear may be of help to you. page 6 of 8

7 Surgery If you have had this condition for a long time, or if physiotherapy and orthotics have not given enough relief to the symptoms, then you may require an operation. You may be investigated with X-rays and a scan before surgery is considered. The type of operation depends on how badly the tendon is damaged and how much the foot has changed shape. If this is the case you will be referred to a Specialist Consultant Orthopaedic Surgeon. Your consultant will then discuss any potential surgery with you and explain which options are appropriate for you. The risks and benefits of any surgery and the expected outcome will also be explained to you. It is important that you understand that after surgery you may need to attend physiotherapy and you may still be required to use orthotic insoles. It can take between 12 and 18 months for the surgery to show any benefit. Contact details Physiotherapy Department Northern General Hospital Royal Hallamshire Hospital Patient Services Team PST@sth.nhs.uk PhysioWorks (Graves Move More Centre) then press option1 for NHS PhysioWorks page 7 of 8

8 Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit Registered Charity No Alternative formats can be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD7282-PIL2892 v3 Issue Date: October Review Date: October 2021