From the Guidelines
Treatment for a large partial tear of the posterior tibial tendon (PTT) should begin with conservative measures, including relative rest, icing, and eccentric strengthening exercises, as most patients with overuse tendinopathies fully recover within three to six months 1. When managing a large partial tear of the PTT, it is essential to prioritize non-surgical approaches initially, given the potential for recovery with conservative therapy. Key components of this approach include:
- Relative rest of the affected area to reduce stress on the tendon
- Icing to help manage pain and inflammation
- Eccentric strengthening exercises to promote tendon healing and strength These measures should be implemented under the guidance of a healthcare professional, with regular follow-up to assess progress and adjust the treatment plan as necessary.
In terms of specific interventions, the use of topical or systemic nonsteroidal anti-inflammatory drugs (NSAIDs) may be considered for acute pain relief, although their long-term use should be cautious and weighed against potential side effects 1. Additionally, techniques such as ultrasonography, shock wave therapy, orthotics, massage, and technique modification may be explored, but their effectiveness is less well-established in the current evidence base 1.
Important Considerations
- Surgery should be reserved for patients who have failed conservative therapy, as it is an effective treatment option but carries inherent risks and requires a prolonged recovery period 1.
- The natural history of overuse tendinopathies, including those affecting the PTT, suggests that most patients can expect to fully recover within three to six months with appropriate conservative management 1.
- Early treatment is crucial to prevent progression of the tear and potential long-term complications, such as flatfoot deformity, emphasizing the importance of prompt and effective management of PTT injuries.
From the Research
Treatment Options for Large Partial Tear of the Posterior Tibial Tendon (PTT)
- Initial treatment for posterior tibial tendon dysfunction, which may include partial tears, is often based on immobilization and rehabilitation 2.
- In cases without clinical improvement or in which tendinitis is associated with partial tendon rupture, open techniques may be used to perform tenosynovectomy and tendon revisions to improve painful symptoms 2.
- Orthotic treatment, including foot/ankle-foot orthoses, footwear, and stretching/strengthening exercises, may be effective in reducing pain in the early stages of posterior tibial tendon dysfunction 3.
- A structured nonoperative management protocol, including the use of a short, articulated ankle foot orthosis or foot orthosis, high-repetition exercises, and aggressive plantarflexion activities, has been shown to be effective in treating stage I and II posterior tibial tendon dysfunction 4.
- Surgical therapy, such as correction of the hindfoot valgus by medializing calcaneal osteotomy, may be necessary in some cases, particularly when there is a significant deformity or degeneration of the posterior tibial tendon 5.
- In cases of complete rupture of the posterior tibial tendon, surgical repair followed by physical therapy and orthotic devices may be necessary, but additional surgical procedures may be needed to halt progression and lessen the chance of persistent pronation deformity 6.
Considerations for Treatment
- The treatment approach may depend on the severity of the tear, the presence of any underlying deformities or degenerative changes, and the patient's overall health and activity level.
- A combination of conservative and surgical treatments may be necessary to achieve optimal outcomes.
- Further research is needed to determine the most effective treatment protocols for large partial tears of the posterior tibial tendon.