Pain noted to the inside portion of the ankle following the course of the posterior tibial tendon to its attachment in the foot. The onset of pain may occur without a noticeable injury event but is more common in adult women more than men who are greater than 50 years of age, associated with being overweight and almost always associated with a preexisting flatfoot.

Symptoms

• Pain to the inside portion of the foot and ankle with initial weight bearing activity.
• Pain noted during walking in the propulsion phase while lifting the heel off of the ground prior to insitiating the next foot strike.
• Pain to the inside ankle while attempting to rise on toes.
• Swelling to the inside portion of the ankle.

Radiology

• Regular x-rays usually are not of benefit to the diagnosis but can show a difference in the arch height between the sympomtatic and non symptomatic foot.
• MRI can show suspected tearing of the tendon at the site of injury.

Treatment

• The short term use of a CAM boot if the pain and disability are severe.  The CAM boot decreases the mechanical looading of this tendon during walking.
• After the use of the CAM boot, or in lieu of the CAM boot, the Aircast PTTD brace can stabilize the tendon allowing continued recovery.
• Use of supportive shoe and orthotic arch support.
• Ice twice daily for 10-15 minutes
• Non-steroidal anti-inflammatory medications like Ibuprofen or Naproxen.
• Compliance to No Barefoot Walking Rule
• Activity limitations Rule

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