Posterior tibial tendon dysfunction is a common condition in women in the 5th decade. The condition is also associated with a number of risk factors: female sex, obesity, hypertension and diabetes.
The condition typically presents with pain and swelling medially (on the inside of the ankle). In the initial stages the foot shape is normal, the pain is activity related and often is worse first thing in the morning when the patient gets out of bed.
Initially plain x-rays taken are normal. The diagnosis is usually made clinically. It can be confirmed with ultrasound or MRI scan if there is a doubt.
In the early stages the condition usually responds to rest. This is done using an insert in the shoe or a removable walking boot.
If the condition progresses surgical treatment is indicated to prevent collapse of the foot long term.
The most commonly performed procedure for this condition, in my practice, is a tendon transfer and heel shift. The surgery is effective but requires a somewhat tedious ten weeks in plaster, the first six of which are non weight bearing.
Following this type of surgery patients experience swelling for six months and the surgery is effective 85% of the time.