Once diagnosed with Posterior Tibial Tendon Dysfunction as evidenced by the “too many toes” sign and the heel rise test, there are some conservative treatments available to help support or slow the progression of the condition. The best treatment for you will depend on how far advanced you are with the disorder.
If caught far enough in advance, minor modifications can be made to shoe gear to help reduce the amount of pronation. Custom orthotics made from plaster molds can be fashioned to give support to the arch. Modifications can be made to the orthotics with time. If pain persists, a steroid shot can be given to help decrease inflammation. The decision to go ahead with a shot must be carefully considered as steroids can weaken ligaments and cause the condition to progress faster. Oral steroids or anti-inflammatory medication may provide some relief, but will not reverse or halt the progression.
In most cases, orthotics will not provide enough relief. In many instances, orthotics are skipped as a treatment and the doctor will recommend a custom ankle brace as the primary treatment. Similar to orthotics, you will be casted for the brace, which will then be sent off to a lab for fabrication. There are many variations to this brace, and they will be fabricated slightly different. This brace laces up the front, extends up around the ankle, and fits into most shoes. It helps to give support to the arch and foot. Movement of the joints in the foot is minimized, thus reducing pain and swelling. If worn consistently, this brace can be a definitive treatment for some individuals. However, the brace can be bulky and difficult to wear during the warm summer months.
Despite our best efforts, some patients will eventually exhaust conservative treatments. At this point, surgical options are explored. Your doctor will probably order an MRI to get an idea of how degenerated the posterior tibial tendon is. This will help the doctor to recommend the best surgical option. We’ll discuss these options next post.