PTTD Series
Part 2 PTTD Case Study
Let’s look at a Posterior Tibial Tendon Dysfunction (PTTD) Clinical Case Study!
Case Study: Medial Ankle Pain and Progressive Flatfoot
A 46-year-old female retail worker presented with progressive pain on the medial aspect of her right ankle for the past eight months. The pain worsened after long shifts and improved with rest. The patient noticed her arch becoming flatter and felt instability when walking on uneven ground.
Clinical Background
The patient reported standing 8–10 hours daily at work and frequently walking barefoot at home. She had a history of mild flat feet since childhood but no previous ankle injuries. Over the past year, a 12‑lb weight gain contributed to increased mechanical load on the medial foot structures.
Symptoms
– Medial ankle pain and swelling
– Increasing flatfoot deformity
– Difficulty performing a single‑leg heel raise
– Fatigue and pain after prolonged walking
– Visible ‘too many toes’ sign on the right side
Clinical Findings
Examination revealed tenderness along the posterior tibial tendon from the medial malleolus to the navicular. Hindfoot valgus deformity along with forefoot abduction was noted during stance phase, however the deformity was flexible and could be reduced during examination. The patient was unable to perform a single‑leg heel rise, indicating tendon insufficiency. Gait analysis demonstrated excessive pronation through mid‑stance.
Answers:
Diagnosis
Posterior Tibial Tendon Dysfunction – Stage II (flexible flatfoot with tendon insufficiency).
Management Plan
– Custom orthotics with medial rearfoot posting and arch reinforcement
– Supportive footwear with firm heel counter (support ankle and help reduce excessive motion)
– Avoid barefoot walking
– NSAIDs as needed for pain
– Posterior tibial strengthening program (eccentric loading)
– Follow‑up every 6–8 weeks to monitor progression
🔗Connect on LinkedIn: www.linkedin.com/company/canada-orthomedix-inc
📲Follow for more content! Like and Comment!
⏰Stay tuned for more on this series!
