The inside of my foot hurtsMarch 11, 2015
Overuse injuries are common in runners and athletes, with a majority of injuries affecting the lower legs. One of these progressive injuries is called Posterior Tibial Tendon Dysfunction or PTTD. If you noticed ankle/foot pain with activity, your foot is starting to appear flat, and your ankle rolls inward, PTTD may be the culprit.
PTTD is common in runners, specifically those who already have a low arch. PTTD involves the tendon that supports the inside structures of your foot. The posterior tibial tendon runs behind the boney bump on the inside of your ankle and attaches to the middle bottom of your foot. This tendon supports the major arch of your foot, especially during walking and running. When there is too much stress on this tendon, it becomes irritated and starts to breakdown. Repetitive activity and overuse can cause the tendon to become inflamed, enlarged, and thickened. The arch of your foot may start to appear flatter since it no longer has as much support as it needs. Pain and swelling can occur at the inside of your foot. Standing on your toes can be very difficult. Additional factors that can increase the risk of developing PTTD include poor fitting shoes, changes in structure of your feet, age, obesity, or increased activity such as walking or running. Increased stress on the tendon can also be caused by weakness in thigh, hip, or calf muscles, making the muscle attached to the tendon work even harder.
- Pain or swelling at the inside of your foot
- Arch of your foot appears flatter
- Ankle begins to roll inward
- Difficulty walking, running, hopping, or jumping
- Difficulty standing on your toes
- Decreased balance
- Weakness around the ankle/foot, especially when trying to bring your foot down and inward.
- Stiffness in your foot, especially in the morning
- Foot that starts to point out towards the side in standing
Stages of PTTD
Stage I: Mild swelling. Pain on the inside of the ankle. Able to stand on toes but painful.
Stage II: Arch of your foot starts to progressively flatten. Foot begins to turn outward. Less pain and swelling.
Stage III: Similar to Stage II but increased pain. May also have pain on the outside of your foot.
How is it Diagnosed?
Your physical therapist will look at your feet, as well as your knees and hips to try and identify the root of the cause. Your therapist may also ask questions about your health history, your activities, and watch how you walk. In some cases, an MRI or ultrasound may be performed in order to confirm the diagnosis or rule out other causes. As with a majority of injuries, early diagnosis will result in a better outcome.
How Can Physical Therapy Help?
After evaluating the strength and motion of your lower leg, your therapist will develop an exercise program to address any weaknesses or deficits they find.
Strengthening – Your therapist will prescribe exercises that target the lower leg and intrinsic foot muscles. These will help increase support and decrease stress around your foot and ankle.
Stretching – Your therapist will show you how to properly stretch the muscles around your lower leg to prevent further irritation of the tendon and increase proper foot motion.
Hands On Therapy – Manual therapy such as joint and soft tissue mobilization can help increase healing, reduce pain, and improve mobility. This will complement your exercise program well and lead to proper recovery of normal foot motion.
Orthotics – Your therapist may recommend orthotics to place in your shoe in order to increase support at the arches of your foot. Your therapist may also recommend proper footwear for your foot type, further decreasing stress to the foot and ankle.
Initially, applying ice, elevating the foot, and resting the foot may help to calm down early symptoms of PTTD, but it does not address the main cause of the problem. Having your physical therapist evaluate how you move and find those weak areas that are causing added stress to your foot and ankle will identify the origin of your symptoms. Then, a permanent solution can be identified. For more information on physical therapy www.totalperformancept.com.