PTTD in Both Feet: Understanding Bilateral Posterior Tibial Tendon Dysfunction
When posterior tibial tendon dysfunction affects both feet, it presents unique challenges that differ from the more common single-foot case. If you’ve been diagnosed with PTTD in both feet, understanding what makes bilateral cases different can help you navigate treatment and management more effectively.
Can PTTD Affect Both Feet?
Yes, PTTD can affect one or both feet. The vast majority of cases affect only one foot—often called “unilateral” PTTD. However, a significant minority of people develop it in both feet, and this is worth understanding.
Bilateral PTTD is less common, but it tends to behave differently and often points to underlying factors that are affecting your body more broadly.
What Causes Bilateral Cases
When PTTD shows up in both feet, doctors typically look for systemic causes—conditions that affect your whole body rather than a single injury or overuse. Several factors can contribute:
Inflammatory Conditions
Rheumatoid arthritis and other autoimmune conditions can affect multiple joints and tendons simultaneously. If you have rheumatoid arthritis, inflammation can weaken the posterior tibial tendons in both feet.
Genetic Predictions
Some people are born with foot structures that make them more prone to developing PTTD. If you have inherently flexible feet or a tendency toward flat arches, both feet may be affected similarly over time.
Systemic Health Factors
Diabetes and hypertension are risk factors for PTTD, and because these conditions affect your entire body, they can contribute to bilateral development.
Age and Wear
Sometimes both feet simply wear down over years of use. If you’ve been on your feet for decades, both posterior tibial tendons may eventually show signs of degeneration.
The key difference with bilateral cases is that doctors are more likely to investigate these underlying systemic factors, since the condition isn’t just a local injury.
How Treatment Differs
Treating bilateral PTTD requires some different considerations compared to unilateral cases:
Activity Modification Becomes Crucial
When you have PTTD in one foot, you can often rely on the other foot for mobility during recovery. With both feet affected, this isn’t possible. Your treatment team will likely be more conservative with activity restrictions and may emphasize cross-training and low-impact exercises from the start.
Orthotics and Bracing
Custom orthotics and ankle braces are cornerstones of treatment for both feet. The challenge is finding a balance that works for your daily life—you need support, but you also need to maintain as much function as possible.
Surgery Planning
If surgery becomes necessary, doctors often space out procedures between feet rather than operating on both at once. This allows for recovery time and lets you use one foot while the other heals.
Rehabilitation Challenges
Physical therapy for bilateral PTTD requires creativity. Traditional exercises that rely on one strong leg may need modification. Your therapist will work with you to find movements that strengthen both feet without overloading either one.
Living with Bilateral PTTD
Managing PTTD in both feet day-to-day requires some adjustments:
- Footwear becomes even more important: Supportive shoes aren’t optional—they’re essential
- Pacing matters more: Without a “good foot” to rely on, you’ll need to be more mindful of how much standing and walking you do
- Home modifications: Consider grab bars in the shower, non-slip mats, and perhaps a shower chair
- Patience with recovery: Healing takes time, and having both feet affected means recovery may feel slower
The good news is that with proper treatment, most people with bilateral PTTD can still lead active lives. The condition is manageable—you just have to be intentional about it.
Sources
- American Academy of Orthopaedic Surgeons (AAOS) - Posterior Tibial Tendon Dysfunction
- Rheumatoid arthritis and foot health literature