Painful Flatfoot or Posterior Tibial Tendon Dysfunction


In earlier stages of this condition before deformity develops, it may be possible to halt the progression entirely by performing non-operative treatments for a period of time.

This disorder encompasses a broad spectrum of severity and has many underlying etiologies which effect its progression. It has also been termed Adult Acquired Flatfoot Deformity. In the early stages, the posterior tibial tendon can be involved in isolation and may develop tendinitis, become stretched, or even develop small tears. This process is often associated with the patient having a tight calf muscle and is likely one of the main underlying etiologies behind its development. Progression leads to flattening of the arch and the heel tilting to the outside (valgus). This represents hindfoot instabilty. The foot may also begin turning towards the outside (abduction). This deformity progresses from flexible to rigid over time. The rigidity develops due to arthritis in the hindfoot joints.


Pain and swelling are usually located either over the posterior tibial tendon on the inside (medial) of the ankle. Once deformity develops, the pain can also involve the outside (lateral) of the ankle around the tip of the fibula. Pain is typically worse with weightbearing.


Conservative treatment involves calf stretching, anti-inflammatory medications, ice, activity modifications, orthotics, physical therapy, braces, special boots, and/or casting. In the earlier stages before deformity develops, it may be possible to halt the progression entirely by performing these non-operative treatments for a period of time and the patient may resume normal activities without having to rely on any type of brace. Once deformity of the hindfoot develops, if non-operative management resolves symptoms, it is often suggested that a brace be worn indefinitely in order to prevent continued deformity and pain. If symptoms cannot be controlled with these non-operative modalities, often surgery is recommended. There are numerous types of surgical procedures to treat this disorder and often several of them need to be combined. The type of procedure(s) to be performed is determined by your surgeon based on the individual characteristics of each patient’s pain, deformity, age, activity level, and arthritic involvement.