If posterior tibial tendonitis (PTTD) goes untreated, it typically progresses, leading to worsening symptoms and potentially significant foot deformity and functional limitations. This condition is known to be progressive, meaning it will continue to deteriorate, particularly if not addressed early. It is often referred to as "adult acquired flatfoot" because it is the most common type of flatfoot that develops in adulthood.
The Progressive Nature of Untreated PTTD
The posterior tibial tendon is crucial for supporting the arch of the foot and allowing it to push off the ground during walking. When this tendon becomes inflamed or torn, its ability to perform these functions diminishes. Without proper treatment, the tendon can further weaken and even rupture, causing the foot's arch to gradually collapse.
The progression of untreated PTTD often involves several stages, each bringing increasing discomfort and structural changes to the foot:
- Initial Inflammation: The tendon becomes inflamed, causing pain along the inside of the ankle and foot.
- Tendon Degeneration: Over time, the inflammation leads to degeneration and weakening of the tendon. It starts to lose its ability to support the foot's arch.
- Arch Collapse (Adult Acquired Flatfoot): As the tendon weakens, the foot's arch begins to flatten. This results in the characteristic "adult acquired flatfoot" deformity, where the foot rolls inward.
- Forefoot Abduction: The front part of the foot may start to point outward, further contributing to the flatfoot appearance.
- Hindfoot Valgus: The heel bone (calcaneus) may shift outward, creating a more pronounced flatfoot deformity.
Compounding Complications
Beyond the structural changes, untreated PTTD can lead to a cascade of related problems as the foot's biomechanics are severely altered.
Worsening Pain and Discomfort
Initially, pain might be localized to the inner ankle. As the condition progresses, pain can spread to the arch, heel, and even the outer side of the ankle due to the foot's compensatory mechanisms. Walking, standing, and physical activity become increasingly painful.
Functional Limitations
The altered foot structure and pain significantly impact daily activities:
- Difficulty Walking: A collapsed arch makes it harder to propel the foot forward efficiently, leading to a noticeable limp.
- Impaired Balance: The instability of the foot can affect balance, increasing the risk of falls.
- Reduced Activity Levels: Many individuals find themselves limiting exercise, sports, and even prolonged standing due to discomfort.
Secondary Foot and Ankle Problems
The mechanical stress from a collapsed arch can lead to other issues throughout the foot and ankle:
- Arthritis: The abnormal alignment can cause excessive wear and tear on the joints of the foot and ankle, leading to the development of painful arthritis.
- Ligament and Tendon Strain: Other ligaments and tendons in the foot may become strained as they try to compensate for the failing posterior tibial tendon.
- Stress Fractures: The altered distribution of weight and stress on the bones can increase the risk of stress fractures.
- Bunions and Hammertoes: The changes in foot shape can contribute to the formation of bunions or hammertoes on other parts of the foot.
Summary of Consequences
The table below summarizes the key events that can occur if posterior tibial tendonitis is left untreated:
| Stage of Progression | Symptoms & Changes | Potential Complications |
|---|---|---|
| Early | Pain/swelling along inner ankle | Mild discomfort with activity |
| Moderate | Arch begins to flatten, pain increases, instability | Difficulty walking, pain during daily activities |
| Advanced | Significant adult acquired flatfoot, heel outward | Severe pain, limited mobility, arthritis, other foot deformities |
The Importance of Early Intervention
Given the progressive nature of PTTD, early diagnosis and treatment are crucial to prevent severe deformity and long-term disability. Treatment options can range from conservative measures like orthotics, bracing, and physical therapy to surgical intervention in more advanced cases. Neglecting the condition almost invariably leads to a worsening of symptoms and a more complex and debilitating problem over time.
