Although there are many lower-extremity diagnoses presented to O&P for consideration and treatment, few are as common as posterior tibial tendon dysfunction (PTTD). This condition is more prevalent than ever, due to factors such as an increasingly overweight population along with an aging population. If left unchecked, PTTD can be a seriously disabling condition; however, proper and early use of orthotics and AFOs along with the correct shoes can halt and even reverse its effects.
The posterior tibial (PT) muscle
originates from the deep posterior compartment of the leg. The PT tendon passes posterior to the medial malleolus, slightly posterior to the ankle joint axis. It then passes medially and plantar to the subtalar joint (STJ) axis. Just posterior to the navicular, the tendon divides into three branches: anterior, middle, and posterior. Collectively, these insert deep onto the plantar arch of the foot including the navicular, all three cuneiforms, the cuboid, and the metatarsals. Due to its location, multiple insertions, and influence over several axes of the foot, the PT muscle plays a critical function in weight-bearing activity.
Four Stages of PTTD