• Chronic Overuse/Degeneration:

• Repetitive Strain: Activities involving high-impact, such as running, basketball, tennis, or walking/climbing stairs, especially when increased suddenly.

• Obesity: Excessive weight increases pressure on the tendon.

• Pre-existing Medical Conditions: Diabetes, hypertension, and inflammatory conditions

• Trauma: Acute injuries such as falls, ankle sprains, or fractures can tear or inflame the tendon.

• Biomechanical Factors: Improper footwear (e.g., lack of support) and abnormal gait.

• Previous Treatments: Prior steroid injections near the tendon can weaken the tissue.

Symptoms may begin as a mild ache or stiffness at the medial ankle and foot pain in the early stages of the disease. Later stages may involve “outside of the foot” lateral pain due to impingement or peroneal tendon injury as well as angular deformities on exam and radiographs

A comprehensive physical examination is crucial for determining the grading and severity of the disease.

Associated findings include:

• Collapse of the arch leads to pes planus (flat foot)

All stages (initially):

Conservative management

• “RICE” Rest, Ice, Compression, Elevation

• Reduction of activity levels.

• Oral medications

• Shoe gear changes/Orthotic/Supportive devices

• Immobilization, walking cast/ CAM boot

• Physical therapy

• Pain laser, extracorporeal shock wave therapy (ESWT)

• Injection Therapy biologic/amniotic, PRP,

Surgical Management is reserved for those who fail conservative treatment. Surgical treatment is based on the Stage of PTTD (posterior tibial tendon dysfunction)

Procedures range from soft tissue repairs (repair the tendon), osteotomy (bone procedures), Tendon transfers/augmentation/reconstruction, Arthrodesis (joint fusions)