Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with insidious onset of medial ankle pain and swelling localized along the course of the posterior tibial tendon in the right foot. Symptoms are exacerbated by prolonged weight-bearing and activity. No history of acute trauma. Patient reports no significant deformity or loss of arch height at this time.
Clinical Examination Findings
Right foot examination reveals tenderness to palpation along the posterior tibial tendon distal to the medial malleolus. No evidence of pes planus or hindfoot valgus. Single-heel rise test is intact and symmetric to the contralateral side. No clinical evidence of tendon rupture or fixed deformity. Neurovascular status is intact distally.
Treatment Protocol
Initiate conservative management for Stage I PTTD: RICE protocol (Rest, Ice, Compression, Elevation), non-steroidal anti-inflammatory drugs (NSAIDs), and activity modification. Prescribe physical therapy focusing on eccentric strengthening of the posterior tibial muscle. Consider custom orthotics or medial arch support to offload the tendon. Follow-up in 4-6 weeks.