Dropped Arches- tibialis posterior dysfunction

Dropped arches could be due to a condition known as posterior tibial tendon dysfunction (PTTD). PTTD when left unmanaged is the most common cause of adult acquired flatfoot and subsequent medial foot pain

What are dropped arches

If you look at the bottom of your feet, you should notice an upward curve on the inside – this is known as your medial arch. Normally, these arches should curve upwards when standing, but if there is a downward sagging or a bone that appears to have moved inwards on the inside edge of your foot, you may have dropped arches.

The medial arch is created by the way the tendons in your feet are attached, specifically a tendon called the tibialis posterior tendon. This crucial band of tissue attaches the calf muscle to the bones on the inside of the foot and serves as one of the major supporting structures of the foot, helping it to function while walking, and is one of the most-worked tendons in the leg.

When this tendon is weakened, injured or worn, changes occur within the tendon which impairs its ability to support the medial arch. This results in a slow flattening of the arch, and is known as posterior tibialis tendon dysfunction (PTTD), adult-acquired flat feet or dropped/fallen arches.

Although this ultimately painful condition typically occurs in one foot (often the leading foot) some people may develop it in both. PTTD is usually progressive, which means it will keep getting worse, especially if it is not treated early.Though flat feet can be attributed to arthritis, neuromuscular diseases, and traumatic injuries, a compromised posterior tibial tendon is the most common cause.

What are the symptoms of dropped arches and tendon dysfunction

The symptoms of PTTD may include pain, swelling, a flattening of the arch and an inward rolling of the ankle. As the condition progresses, the symptoms will change. It is generally an overuse condition, meaning that it is caused by repetitively overloading and straining the tendon past its limits, which results in damage, inflammation and ultimately loss of function.

1. Initially there is often pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen.
2. As the condition progresses, the symptoms tend to change. There is increasing pain on the inside of the foot and ankle as the arch flattens and foot and toes begin to turn outward and the ankle rolls inward.
3. As PTTD becomes more advanced, the arch flattens more and the pain often shifts to the outside of the foot, below the ankle. This is due to the large amount of rotation with subsequent impingement on the outside ankle. In very advanced stages the tendon may tear completely.
4. In addition to this, secondary problems can occur due to the changes in the foot position, such as plantar fasciitis, tendonitis, and arthritis of the foot and ankle.

Pain with PTTD is often worse with activity, especially high-intensity or high-impact activities, such as running. Some people can have trouble walking or standing for a long time.

What causes dropped arches

Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.

Poor strength through the hip abductors can allow inward rotation of the knee and extra stress through the arch and posterior tibialis tendon.

An acute injury, such as from a fall, can tear the posterior tibial tendon or cause it to become inflamed. The tendon can also tear due to overuse. Once the tendon becomes inflamed or torn, the arch can slowly fall (collapse) over time.

Dropped arches are more common in women and people older than 40 years of age. Additional risk factors include obesity, diabetes, and hypertension. If you have played high-impact sports such as basketball, tennis, or football, this may have contributed to a torn or stretched tendon from repetitive use.

How long does it take to treat dropped arches

Symptoms will be relieved in most cases with appropriate conservative treatment. Pain may last longer than 3 months even with early treatment. If you have had pain for many months, it is not uncommon for the pain to last another 6 months after treatment starts.

How are dropped arched treated

Physiotherapists are the go-to leading health care professionals for treating this common overuse injury. The first stage of treatment involves actively breaking the cycle of inflammation and pain leading to the area becoming more sensitive. To do this we need to offload the tibialis tendon, the duration of which will depend on the severity of your symptoms and current activity training load. We will also utilise every hands-on physiotherapy treatment at our disposal to help get your pain under control and asses any contributing bio-mechanical factors.

Because of the progressive nature of dropped arches, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery, and progression can be halted.

In many cases of PTTD, treatment can begin with nonsurgical approaches like:

Shoe modifications - Special inserts or insoles designed to improve arch support can be used.

Physiotherapy, taping, bracing and graded incremental strengthening of the tibialis posterior muscle will help rehabilitate the tendon and muscle. These exercises are combined with generalised lower limb strengthening and proprioceptive balance and co-ordination work.

Immobilisation - Sometimes a boot needs to be worn to immobilise the foot and allow the tendon to heal, or you may need to completely avoid all weightbearing for a while.

Medications - Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.

Surgery may be indicated in advanced cases where conservative methods have been exhausted.

If you have any questions about posterior tibial tendon dysfunction or adult acquired flat foot or would like to book an appointment, give us a call on 83462000 or request a booking online below.