Flat foot (pes planus) is one of three basic foot types. There are also high arched feet (pes cavus) and a normal arch (rectus foot type). Flat foot is when the arches on the inside of your feet are flattened which causes the sole of the foot to touch the floor when standing upright. Some people are born with flat feet. Flat feet can also occur after an injury, or after years of wear and tear to the soft tissues of the arch and ankle. Some people never experience any pain or symptoms associated with flat feet, while others experience pain with every step they take.  

Posterior tibial tendon dysfunction, also known as progressive collapsing foot deformity, occurs with aging and wear and tear, resulting in a painful flat foot. It occurs when chronic stress is placed on the posterior tibial tendon and other soft tissue structures of the arch, resulting in inflammation and sometimes tearing of the tendon. Posterior tibial tendon dysfunction can occur with underlying deformity or arthritis. 

The posterior tibial tendon is an important muscle for the foot and ankle, as it helps to support the foot and hold up the arch when walking. Once the tendon becomes inflamed and/or torn, it can lead to a progressive collapse of the arch and a progressive deformity of the foot. This can lead to pain in the arch, heel and ankle. Pain can lead to gait abnormalities, which can result in hip, knee and back pain. 

Treatment of posterior tibial tendon dysfunction depends on severity. Rest, ice, compression, elevation and anti-inflammatory medications can all be used to initially treat pain and inflammation. Orthotics/inserts, CAM boots, or ankle braces may all be used to help support the foot and treat symptoms. Physical therapy and steroid injections can also be indicated in certain circumstances. Surgical intervention is typically recommended when pain is interfering with a patient’s hobbies, work and activities of daily living. Surgery consists of repairing or replacing the damaged tendon and correcting any deformity of the foot to protect the repair. This includes bone cuts and bone fusions to realign the foot under the leg and recreate the arch. A calf lengthening is also indicated in some patients to help reduce biomechanical stress on the foot and attempt to prevent recurrence. Patients typically have to be completely non-weight bearing for six to eight weeks while their bones and soft tissues heal. This is typically followed by physical therapy, depending on the patient’s age and activity. 

If you are concerned that you may have posterior tibial tendon dysfunction or painful flatfoot, talk to your orthopedic/podiatric provider today.