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Updated: May 2 2025

Posterior Tibial Tendon Insufficiency (PTTI)

Images
  • summary
  • Epidemiology
  • Etiology
  • Anatomy
  • Classification
  • Presentation
  • Imaging
  • Differential
  • Treatment
    • Nonoperative
      • ankle foot orthosis
        • indications
          • initial treatment for stage II, III, and IV
          • also for patients who are not operative candidates, sedentary/low demand (age > 60-70)
        • technique
          • AFO family of braces (Arizona, molded, articulating)
            • AFO found to be most effective
            • want medial orthotic post to support valgus collapse
            • Arizona brace is a molded leather gauntlet that provides stability to the tibiotalar joint, hindfoot, and longitudinal arch
      • immobilization in walking cast/boot for 3-4 months
        • indications
          • first line of treatment in stage I disease
      • custom-molded in-shoe orthosis
        • indications
          • stage I patients after a period of immobilization
          • stage II patients
        • technique
          • medial heel lift and longitudinal arch support
            • medial forefoot post indicated if fixed forefoot varus is present
            • UCBL with medial posting
    • Operative
      • tenosynovectomy
        • indications
          • indicated in stage I disease if immobilization fails
      • FDL transfer, calcaneal osteotomy, TAL, ± forefoot correction osteotomy ± spring ligament repair ± lateral column lengthening ± medial column arthrodesis ± PTT debridement
        • indications
          • stage II disease
          • lateral column lengthening for talonavicular uncoverage
          • medial column arthrodesis if deformity is at naviculocuneiform joint
        • contraindications
          • hypermobility
          • neuromuscular conditions
          • severe subtalar arthritis
          • obesity (relative)
          • age >60-70 (relative)
      • first TMT joint arthrodesis, calcaneal osteotomy, TAL ± lateral column lengthening ± PTT debridement
        • indications
          • stage II disease with 1st TMT hypermobility, instability or arthritis
      • isolated subtalar arthrodesis
        • indications
          • absence of fixed forefoot deformity
        • contraindications
          • fixed forefoot supination/varus
            • otherwise will overload lateral border of foot
          • joint hypermobility
      • hindfoot arthrodesis
        • indications
          • typically triple arthrodesis
          • stage II disease with severe subtalar arthritis
          • subtalar and talonavicular arthrodesis can be considered
          • risks included lateral plantar nerve irritation and FHL impingement from long interlocking screw 
      • triple arthrodesis and TAL + deltoid ligament reconstruction
        • indications
          • stage IV disease with passively correctable ankle valgus
      • tibiotalocalcaneal arthrodesis
        • indications
          • stage IV disease with a rigid hindfoot, valgus angulation of the talus, and tibiotalar and subtalar arthritis
  • Techniques
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Question
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Foot & Ankle⎜Posterior Tibial Tendon Insufficiency (PTTI)
  • Foot & Ankle
  • - Posterior Tibial Tendon Insufficiency (PTTI)
22:2 min
10/16/2019
2782 plays
4.7
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