PTTD and Arthritis: Understanding the Connection

If you’ve been diagnosed with posterior tibial tendon dysfunction, you might have heard that arthritis can develop as a complication. It’s a legitimate concern, and understanding the connection between these two conditions helps you know what to watch for and how to protect your joints.

How PTTD Leads to Arthritis

The relationship between PTTD and arthritis is indirect but real. Here’s what happens:

When the posterior tibial tendon weakens or tears, it can’t properly support your arch. This causes your foot to flatten—something called pronation. Over time, this altered mechanics puts abnormal stress on the joints in your foot and ankle.

Think of it like tires on a car that are out of alignment. They wear down faster because the pressure isn’t distributed evenly. Similarly, the joints in your foot experience uneven pressure when your arch collapses, and this can lead to wear and tear on the cartilage—the smooth tissue that cushions your joints.

This process doesn’t happen overnight. Arthritis from PTTD typically develops in the later stages of the condition, particularly stage 3, when the deformity has progressed significantly.

Signs Arthritis Is Developing

Arthritis doesn’t always announce itself clearly, especially in its early stages. Here are some signs to watch for:

  • Stiffness that improves with movement: Many people notice their feet feel stiff when they first wake up but loosen up after walking around
  • Grinding or clicking: Called crepitus, this sensation when moving your foot can indicate cartilage wear
  • Pain in the midfoot: Arthritis from PTTD often shows up as pain in the middle of your foot, particularly when pushing off while walking
  • Swelling that doesn’t go away: Unlike the intermittent swelling that can come with active PTTD, arthritis-related swelling tends to be more constant

If you’re experiencing these symptoms, mention them to your doctor. X-rays can show whether arthritis is present in your foot joints.

Treatment When Arthritis Is Present

Having arthritis doesn’t mean treatment options disappear—it just means your approach needs to be more nuanced:

Conservative Treatments

  • Anti-inflammatory medications: Over-the-counter NSAIDs can help manage pain and inflammation
  • Physical therapy: Focused exercises to improve joint mobility and strengthen supporting muscles
  • Custom orthotics: Specially designed inserts that can help redistribute pressure away from arthritic joints
  • Supportive footwear: Shoes with good arch support and stiff soles reduce stress on joints
  • Cortisone injections: Can provide temporary relief for inflamed joints

Surgical Options

When arthritis is severe and conservative treatments aren’t enough, surgery may be recommended. The type of surgery depends on how advanced both the PTTD and arthritis are:

  • Joint-preserving procedures: In early-stage arthritis, some surgical options can realign the foot to take pressure off the affected joint
  • Fusion surgery: For advanced arthritis, fusing the damaged joint can eliminate pain by preventing movement in the arthritic joint
  • Arthritis itself may affect surgical options: If significant arthritis is present, some reconstructive procedures may be less effective, so your surgeon will tailor the approach to your specific situation

Prevention: Protecting Your Joints

The best approach is preventing arthritis from developing in the first place—or catching it as early as possible:

  1. Get diagnosed early: The sooner PTTD is treated, the less likely joint damage becomes
  2. Stay consistent with treatment: Wear your orthotics, do your exercises, and follow your doctor’s recommendations
  3. Maintain a healthy weight: Less body weight means less stress on your foot joints
  4. Stay active wisely: Low-impact exercises like swimming and cycling are easier on your joints than high-impact activities

The Bottom Line

Yes, PTTD can lead to arthritis—but it doesn’t have to. Many people with PTTD never develop significant arthritis, especially when the condition is caught early and managed properly. If you already have some arthritis, modern treatments can still help you maintain mobility and reduce pain.

The key is paying attention to your symptoms, seeing your doctor regularly, and staying proactive about treatment. Your joints will thank you for it.

Sources

  • American Academy of Orthopaedic Surgeons (AAOS) - Posterior Tibial Tendon Dysfunction
  • Arthritis Foundation - Osteoarthritis of the foot and ankle