How is posterior tibial tendon dysfunction diagnosed?
Your healthcare provider will look for swelling along the posterior tibial tendon in your ankle and foot. They’ll move your foot from side to side and check your ankle’s range of motion. Swelling, tenderness and pain or weakness when moving your foot or ankle are early signs of PTTD.
Your provider will examine your foot from behind to look for any changes in its structure or shape. Your heel may point outward, and your inner arch may rest flat on the ground. The front of your foot may also move away from your body to counterbalance the changes to the heel and inner arch.
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From behind your foot, your provider will also look for a “too many toes” sign. In a normal foot, only the fifth toe (pinky toe) and part or all of the fourth toe (ring toe) are visible on the outside of the foot. In those with PTTD, more toes may be visible.
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A single-limb heel rise test can also determine the health of your posterior tibial tendon. For this test, you’ll stand next to a wall or chair to support your balance. Then you’ll raise your healthy foot off the ground and attempt to lift onto the toes of your affected foot. With a healthy tendon, you should be able to complete eight to 10 heel raises comfortably. In the early stages of PTTD, it may not be possible to complete one single heel rise.
What tests can diagnose posterior tibial tendon dysfunction?
Imaging tests can help your healthcare provider confirm the diagnosis, including:
- X-rays: X-rays of the front, back and sides of both feet will provide detailed images of the bones. X-rays help spot arthritis or fallen arches. They also help spot joint degeneration in later stages of PTTD.
- Magnetic resonance imaging (MRI): An MRI can determine the health of your tendon and any surrounding muscles. In the early stages, an MRI may be used to plan nonsurgical treatments. In later stages, an MRI may be used to plan surgical treatment.
- Computerized tomography scan (CT scan): A CT scan creates a 3D image of your soft tissues and bones. It provides more detailed images than an x-ray. A CT scan may help spot arthritis or confirm PTTD.
- Ultrasound: An ultrasound can examine the size of your tendon, observe any tendon degeneration or spot fluid in the tissue that surrounds the tendon, which may appear in the early stages of PTTD.
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