With the NCAA tournament well under way, players are most likely doing their best to avoid any type of injury.  An injury common in athletes refers to posterior tibial tendonitis; however, this injury can occur in nonathletes as well.  The posterior tibial tendon courses along the back of the leg then on the inside of the ankle to the arch of the foot.  It functions to support the arch of the foot.

Posterior tibial tendonitis can occur due to injury or overuse.  There are certain risk factors to the development of posterior tibial tendonitis including being overweight, diabetes, and flat feet.  When the tendon’s function is compromised the arch of the foot may drop placing even more pressure on the tendon which can lead to inflammation.

Symptoms of posterior tibial tendonitis include tenderness or pain on palpation of the course of the tendon.  There may also be pain on the inside of the foot and ankle in walking.  Standing on the tips of the toes may also elicit pain due to weakness.  These symptoms progress as the condition advances.   Treatment of the condition includes non-steroidal anti-inflammatory reactions, applying ice for about 20 minutes two times daily, and rest.  Increasing the arch support of the shoe or adding orthotics can also help control the condition. 

If untreated and with continued overuse, posterior tibial tendonitis can progress to posterior tibial tendon dysfunction (PTTD), causing a progressive flatfoot deformity.   In addition to the above symptoms this may lead to arthritis and a change in gait, or the way a person walks.  The change in gait may even lead to pain in other areas involved in mobilization such as the knees, hip, and back.   With this said, it is important once symptoms begin to seek medical attention and to follow physician instructions to avoid progression.

If you are suffering from posterior tibial tendonitis, please do not wait to see a podiatrist.  The physicians at Atlantic Foot and Ankle Associates take a conservative approach for all types of injuries.   Make an appointment at one of our four offices conveniently located in Palm Coast, Orange City, Daytona Beach, and Port Orange and get back to walking pain free!

By Dr. James Rust

Flatfeet, or Pes Planovalgus, is a term with a very vague description of decreased arch height as someone stands down on the ground.  Kelly Osborne of Dancing with the Stars has suffered from shooting pains as a result of flat feet.  It is well known that this foot condition is a precursor to foot problems ranging from general foot pain/fatigue, bunions, hammertoes, ball-of-foot pain, arch pain, and ankle pain.

There are four basic stages of flatfeet that are directly related to the degree of pain and correlating treatment, ranging from non-surgical to surgical:

1. The first stage usually is associated with general foot pain with mild to aggressive activity and long periods of standing. Initial X-rays are usually taken to determine if there are any signs of arthritis. At Atlantic Podiatry Associates, we typically recommend arch supports, good supportive shoes and anti-inflammatory medications, which are a great start and usually reduce pain significantly.
2. The second stage is associated with more pain and possible changes seen as a slight drop in the arch with more swelling. At this stage the treatment is typically a special walking boot and a possible MRI to visualize the tendons to see if there is any tear within the tendon.
3. The third stage typically is quite severe. There may be pain with every step and the foot has turned outwards; it is hard to move the joints in the arch. Treatment at this stage typically needs aggressive custom ankle-foot braces or orthotics (arch supports) for shoes. If pain is not controlled, surgery may be indicated.
4. The final stage is a painful foot and ankle that is debilitating. This is the “end stage” with a large majority needing foot and ankle fusion-type procedures aimed at moving the foot back underneath the ankle. Surgery is reserved for patients who fail conservative treatments.

A large majority of our patients ranging from Port Orange to Palm Coast find great relief with a custom arch support made from a mold of their foot. The custom inserts fit in athletic shoes and can ease the pressure on the fallen arch, decreasing pain and allowing for more activity.

It is important to address flatfeet to prevent “arch breakdown”. The idea is keep a person from progressing through any of the above stages. This can only be accomplished by supporting the weakened flat arch.

By, Dr. Dennis McBroom