The document discusses Posterior Tibial Tendon Dysfunction (PTTD), a common cause of acquired flatfoot in adults. PTTD occurs when the posterior tibial tendon, which connects the calf muscle to the bones on the inside of the foot and ankle, becomes damaged or inflamed over time. This can lead to a collapsed arch. PTTD is most often seen in middle-aged women, individuals with a history of obesity, hypertension, or diabetes, and may result from prior foot trauma. The condition is progressive and painful, and can cause permanent foot deformity if not treated. In later stages, surgery may be the only treatment option.

1. Posterior Tibial Tendon
Dysfunction:
Pulling it all together
(Aerosmith, 2008, I tunes download)

2. Major Points
• The human body depends on tendons to connect muscles to
bones and to stretch across joints allowing for movement
(American Orthopaedic Foot and Ankle Society, 2017)
• Posterior Tibial Tendon Dysfunction (PTTD) is a common cause of
acquired flatfoot in adults (Kohls-Gatzoulis et al., 2004)
• PTTD is most commonly seen in middle age women, individuals
with a history of obesity, hypertension, or diabetes. PTTD may
present in people who have suffered prior trauma to the foot
(Bubra, Keighley, Rateesh and Carmody, 2015).

3. • The posterior tibial tendon is hypo-vascularized where it extends
around the medial malleolus. This area is prone to damage and
rupture (Satomi et al., 2008).
• For some people, microscopic changes in collagen structure and
synthesis may interfere with tendon structure (Satomi et al.,
2008 and Erol et al., 2015).
• PTTD is diagnosed in stages (I-IV) (Bubra et al., 2015).
• PTTD is painful, inflammatory in nature, and debilitating with a
tendency to cause permanent foot malformation. In later
stages, surgery may be the only treatment option.

4. A Personal Reflection
Pictured Left- Dr. Kevin Bryant My Foot X-ray
My x-ray showing pathologic flat foot changes in
the lateral view

6. References
• Aerosmith (1980). Walk this way. Aerosmith’s Greatest Hits [I tunes download]. New York, NY: Columbia Records
• American Orthopaedic Foot and Ankle Society. (2017). Progressive flatfoot (posterior tibial tendon dysfunction).
Retrieved from http://www.aofas.org/footcaremd/conditions/ailments-of-the-midfoot/Pages/Progressive-
Flatfoot.aspx
• Bubra, P., Keighley, G., Rateesh, S., & Carmody, D. (2014). Posterior tibial tendon dysfucntion: An overlooked
cause of foot deformity. Journal of Family Medicine and Primary Care, 4(1), 26-29. doi: 10.4103/2249-
4863.152245
• Erol, K., Karahan, A., Kerimoglu, U., Ordahan, B., & Tekin, L. S. (2015). An important cause of pes planus: the
posterior tibial tendon dysfunction. Clinics and Practice, 5(699), 11-13.
• Kohls-Gatzoulis, J., Angel, J., Singh, D., Haddad, F., Livingstone, J., & Berry, G. (2004). Tibial posterior dysfunction:
A common and treatable cause of adult acquired flatfoot. British Medical Journal, 329, 1328-1333.
• Satomi, E., Teodoro, W., Parra, E., Fernandes, T., Velosa, A., Capeozzi, V., & Yoshinari, N. (2008). Changes in
histoanatomical distribution of types I, III and V collage promote adapative remodeling in posterior tibial tendon
rupture. Clinics, 63(1), 9-13. doi: 10.1590/S1807-59322008000100003