Posterior Tibial Tendon Dysfunction

This review focused on the aetiological factors, epidemiological features, and pathogenesis of Posterior Tibial Tendon Dysfunction (PTTD). It aims to analyse, discuss, and debate the current understanding of PTTD using the available literature.

The posterior tibial tendon (PTT) originates from the posterior aspect of the interosseous membrane and from the superior two-thirds of the medial part of the posterior aspect of the fibula.

Little information is available relating to the epidemiological features of PTTD; however, what is available suggests that middle-aged women and older people are the most common groups affected.

Researchers working in the field of musculoskeletal medicine differ in their opinions regarding the causes of PTTD, describing the condition as having an unknown aetiology or a poorly understood complex aetiology.

Because the pathogenesis of the development and progression of PTTD involves the disruption and disorganisation of specific tissues in the tendon, the aetiology of the condition is multifarious.

It has been suggested that the spring ligament has some involvement in the development

of PTTD. However, there remains some debate over the anatomical makeup of the spring ligament itself.

A variety of studies have attempted to analyse the histologic features of the tendon and the histochemical changes that take place in the presence of dysfunction.

Early-stage PTTD is characterised by an acute tendinitis giving rise to inflammatory cell proliferation and with progression of the deformity, continued collagen disorientation with vascular ‘‘ingrowth’’ becomes a prominent feature.

Currently, the classification models used in clinical practice include surgical interventions for stages of PTTD, in addition to suggestions for conservative management in the early stages; however, the crucial link here is early diagnosis.

The existing prevalence studies have shown that this condition is poorly diagnosed.

Therefore, any new research that could raise awareness among health care professionals to aid early diagnosis and immediate conservative treatment can be viewed only as a positive step forward.


  1. Durrant, B., Chockalingam, N., Hashmi, F. (2011) Posterior Tibial Tendon Dysfunction. Journal of the American Podiatric Medical Association: March/April 2011, Vol. 101, No. 2, pp. 176-186

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