Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with insidious onset of medial ankle pain localized along the course of the posterior tibial tendon. Symptoms are exacerbated by weight-bearing activities and prolonged standing. No history of acute trauma. Pain is described as a dull ache, currently rated at [X]/10. Patient denies numbness, tingling, or mechanical locking.
Clinical Examination Findings
Left foot examination reveals mild edema and tenderness to palpation along the posterior tibial tendon sheath, posterior to the medial malleolus. No significant deformity or flattening of the medial longitudinal arch noted. Single-heel rise test is intact but elicits discomfort. Muscle strength of the posterior tibial tendon is graded 4+/5. Neurovascular status is intact distally.
Treatment Protocol
Conservative management initiated for Stage I PTTD. Plan includes: 1) Activity modification and avoidance of high-impact loading. 2) Prescription of a medial longitudinal arch support or custom orthotic. 3) Initiation of physical therapy focusing on strengthening the posterior tibial tendon and intrinsic foot muscles. 4) NSAIDs as needed for inflammation control.