Flatfoot (Adult acquired)
Description
Tendons do a lot of work. In fact, a great deal of what happens when
you walk can be related to tendons tugging and pulling in
appropriate ways in their proper places. With this in mind, it’s
hardly surprising that on occasion, (probably because we too often
forget to send them ‘Thank you’ cards), tendons may decide that
they’ve had it. They may buck their responsibilities, shirk their
work, and in all other ways cease to function properly. And that may
mean bad news for you.
Take the posterior tibial tendon: it runs from the bottom of the
calf, goes right under that bump on the inside of the ankle (the
medial malleolus) and ends up attaching itself to a bone on the
inside of the middle of your foot (the navicular bone). It’s the
main tendon that keeps the arch of your foot in place, and it helps
a bunch in walking, too. Over time, though, we tend to put a lot of
stress on this faithful tendon, especially if we’ve put on extra
weight, or do a lot of activities that stress it out: walking,
running, hiking, or climbing stairs. Sometimes athletes (who do a
lot of that walking and running stuff) may put so much stress on the
tendon that it tears suddenly. But for many of us, damage may take
place gradually (i.e. the tendon stretches out) until the tendon
tells us that it flat out quits. (It sometimes doesn’t even give two
weeks notice.) In short, you may develop posterior tibial tendon
dysfunction (PTTD).
There are a few other things that can weaken the tendon (and thus
move that quitting time a little closer). Women are much more likely
than men to develop this condition, and it often takes place around
the same time as menopause (around age 60 or so). Steroid use (not
always illegal-this may come from having cortisone shots in the
area) and smoking may also increase the likelihood for developing
PTTD, since steroids tend to weaken tendons. A history of injury in
the area, arthritis, or an already flat foot may also serve to push
the tendon to declare, “That’s the last straw!” (Silly tendon. As if
it even knows what straw is.)
Symptoms
Symptoms shift around a bit, depending on what stage of PTTD you’re
in. For instance, you’re likely to start off with tendonitis, or
inflammation of the posterior tibial tendon. This will make the area
around the inside of your ankle and possibly into your arch swollen,
reddened, warm to the touch, and painful. Inflammation may actually
last throughout the stages of PTTD. The ankle will also begin to
roll towards the inside of the foot (pronate), your heel may tilt,
and you may experience some pain in your leg (e.g. shin splints).
As the condition progresses, the toes and foot begin to turn
outward, so that when you look at your foot from the back (or have a
friend look for you, because-hey-that can be kind of a difficult
maneuver to pull off) more toes than usual will be visible on the
outside (i.e. the side with the pinky toe). At this stage, the
foot’s still going to be flexible, although it will likely have
flattened somewhat due to the lack of support from the posterior
tibial tendon. You may also find it difficult to stand on your
toes.
Finally, you may reach a stage in which your feet are inflexibly
flat. At this point, you may experience pain below your ankle on the
outside of your foot, and you might even develop arthritis in the
ankle.
Diagnosis
Your podiatrist is very familiar with tendons that have just about
had enough, and will likely be able to diagnose this condition by
performing a physical exam of your foot. He or she will probably
examine the area visually and by feel, will inquire about your
medical history (including past pain or injuries), and may also
observe your feet as you walk. You may also be asked to attempt
standing on your toes. This may be done by having you lift your
‘good’ foot (the one without the complaining tendon) off the ground,
standing only on your problem foot. (You may be instructed to place
your hands against the wall to help with balance.) Then, your
podiatrist will ask you to try to go up on your toes on the bad
foot. If you have difficulty doing so, it may indicate a problem
with your posterior tibial tendon.
Some imaging technology may be used to diagnose this condition,
although it’s more likely the doctor will rely primarily on a
physical exam. However, he or she may order scans such as an MRI or
CT scan to look at your foot’s interior, and X-rays might also be
helpful in a diagnosis.
Treatment
Treating PTTD is almost always easier the earlier you catch it. So,
the first step in treatment is to see your doctor as soon as you
begin experiencing painful symptoms. However, once your condition
has been diagnosed, your podiatrist will likely try to give the
upset tendon a bit of a break so it’ll calm down and stop being so
painful. This can often be accomplished by immobilizing the foot
using tape and padding, braces, or casts, depending on what your
podiatrist believes will work best for you, and depending on the
severity of your condition.
You may also be instructed to reduce inflammation by applying ice to
the area (usually 40 minutes on and 20 minutes off, with a thin
towel between you and the ice). Or, you might take anti-inflammatory
medications like ibuprofen (steroidal anti-inflammatory meds are
actually likely to make this problem worse, and are not usually
recommended in treating PTTD), or use ultrasound therapy.
Once the inflammation has gone down a bit, your podiatrist may
recommend using orthotics (prescription shoe inserts) to support
your damaged arch. Ankle braces can also be helpful.
If these conservative treatments fail to rein in your rogue tendon,
then surgery may be necessary to reduce your pain. Your doctor can
talk with you about surgical options available to you. These may
include tendon transfers, bone fusion, and bone grafts.
If all goes well, (and if you treat it with the proper respect it
deserves), your tendon should get back to work just fine.
Call 719-543-2476 today to schedule your appointment!
