“I used to have an arch, and now my arch seems to be falling!” You may have heard this complaint from your friends or family, or you may be experiencing this yourself, right now. “Fallen arches” or Adult Acquired Flat Foot are two common names for what is known as Posterior Tibial Tendon Dysfunction (PTTD).
What was once a disabling condition, is now very treatable, as long as it is diagnosed early. Conservative treatment, including rest, stretching and strengthening exercises, foot massage, and anti-inflammatory medication are important and required. More important are orthotics and supportive foot wear, which should be used on a daily basis. Some of the best shoes for posterior tibial tendon dysfunction all have two features in common:
They all have a rigid sole, and a slight heel.
Symptoms & Causes of PTTD
The Posterior Tibial Tendon (PT Tendon) is one of the most important tendons in your foot and ankle. It is a tendon that runs along the inside of your ankle, and down into your foot. The PT Tendon is important in maintaining and supporting your arch height. The tendon acts like a fulcrum, helping to hold your arch up, and creating a supination force (an inward rotation of your foot, which helps with stabilizing the foot and ankle).
PTTD is most common in women over 40, specifically menopausal and post-menopausal women are more likely to acquire PTTD. PTTD also occurs in older adults, overweight or obese patients, Diabetics, and can happen with a limb length discrepancy, where one leg is longer than the other.
Less commonly, PTTD occurs in athletes, when they have an overuse injury of the PT tendon. This happens when an athlete engages in high impact activities, which puts increased stress and tension on the tendon, which causes inflammation, and dysfunction of the PT tendon.
If you do start to notice that your arch is falling, or you have pain in the inside of your ankle, it is important to get it examined by your doctor. Many times, the clinical examination alone can determine if you have a PTTD.
An exam called the “one leg heel raise” is done, where the patient is asked to stand on the affected leg, and stand up on his/her tip toes. Many people have pain while doing this exercise, or some may not be able to do it at all. This is a sure sign of a PTTD.
To get a more accurate assessment of the precise location of the tear or inflammation, a diagnostic ultrasound or an MRI may be done. At this point the doctor may tell you the Stage of PT Tendon Dysfunction that you have. If caught early at Stage I or Stage II, the PTTD can be treated and the pain alleviated.
4 Stages of PTTD
There are 4 stages of PTTD. The classification by Johnson and Strom (1989) is the most commonly used.
In Stage I, the tendon is inflamed, but there are little if any noticeable changes to the tendon, and the tendon is intact.
By Stage II, there is a visible “fallen arch” deformity of the foot, with increased pain and inflammation.
Stage III is an advanced foot deformity, with arthritis, and a very visible “fallen arch”.
Finally, at Stage IV, the ankle joint has started to get affected and there is pain and arthritis in the ankle joint.
One of the important treatment measures are orthotics or inserts for shoes. Custom molded orthotics are undoubtedly the best, since they are customized to each person’s individual foot, and their specific deformity. However, pre-fabricated orthotics are also available, which will help.
The Sole Softec Ultra-U-Arch support inserts, as well as the Superfeet Black Premium Insoles offer the next level of orthotics or inserts which will aid in supporting the posterior tibial tendon thereby alleviating pain and further inflammation.
The Best Running Shoes for PTTD
Some of the best shoes in the market today for running are designed specifically to stop pronation, and to prevent excessive stress to be placed on the PT tendon.
Some of the best running shoes for Posterior Tibial Tendon Dysfunction in the market are:
Saucony has the designation of being the oldest running shoe. Saucony was started on the Banks of Saucony Creek, in Kutztown, PA, in 1898. They also manufactured their shoes solely in the United States, until 1994.
This particular shoe, the ISO Running shoe has a rubber sole, for shock absorption, and a slight heel raise of 29mm, as well as a power grid midsole, providing increased support in the arch. The best part, is that it does accommodate orthotics, either custom or pre-fabricated.
New Balance is one of the only shoe companies that still solely manufactures its shoes in the United States. Because of that, the prices of the shoes are a bit higher. New Balance was founded in Boston, MA in 1906.
The New Balance 1540v2 has a rubber sole, for shock absorption, and an Acteva Lite midsole. Many runners appreciate this type of midsole, as it is lighter than the standard foam material, yet it delivers the same amount of support to the arch.
Another popular running shoe, the 990v4 has a unique feature of an Encap Midsole, as well as an Encap Heel. An Encap is made from an Eva midsole, which is a type of closed cell foam which creates a unique cushioning effect, without taking away from the stability it provides in the arch. This is important for runners who run on varying terrain, and uneven ground. This shoe also has a rubber sole for shock absorption.
The Best Dress Shoes for PTTD
While shopping for dress shoes with a PTT Dysfunction, there are two important factors to keep in mind; the stiffness of the shoe, as well as the cushioning it provides. Stiffness means that there should be no bending, and no twisting when stress is placed on the sole of the shoe. However, you do need to look for cushioning in the shoe as well. The cushioning will provide for shock absorption. Leaving either the stiffness or the cushioning out will cause pain and fatigue of the foot, exacerbating the Posterior Tibial tendonitis.
Some of the best dress shoes for Posterior Tibial Tendon Dysfunction in the market are:
1. Ecco Shoes: Ecco Men's Oxford
These shoes are manufactured in Denmark, and was founded in 1963. In 1990, Ecco formed an organization in the United States and since then, the United States has become the largest market for Ecco Shoes.
Ecco Men’s Oxford, which has a 1” heel, which is important to have since a heel will remove the pronation forces on the foot and decrease the pain that those pronatory forces will have on the Posterior Tibial tendon. This Oxford has a rubber sole for shock absorption as well as a polyurethane outsole for traction while walking on all types of terrain.
2. Cole Haan Shoes: Cole Haan Shoe for Men
These shoes had its start in Chicago, Illinois in the United States in 1928. They have become globally recognized and are sold across the world. Cole Haan Shoe for Men, which has a 1” heel, important for Posterior Tibial Tendon Dysfunction. It is also very easy to slip into, with no hassle of laces, and it has a rubber sole for shock absorption.
3. Clarks Shoes for Women
The Clarks shoe is internationally recognized, and was founded in Somerset, England in 1825.
Whatever your style in dress shoes for women, Clarks has it, and they seem to do it very well. Whether you like the Clarks Women’s Dress Pump, the Slip-on Loafer, or the traditional Mary Jane pump, they all have some important features in common which will help to support a painful PTT Dysfunction. They all have a 2-3” heel, which is again important in alleviating the pronation forces on the foot, and they all have a rubber sole, so important for shock absorption.
4.Dansko Shoes: Minnette Shoe for Women
The Dansko shoes were founded in 1990 by a husband and wife team in West Grove, Pennsylvania, USA. They are now sold in Australia, New Zealand, Asia, and North America.
The Dansko Minette Shoe is a Mary Jane style dress shoe which is 2” in heel height, important in minimizing the pronation forces. It also has a removable arch support and memory foam for cushioning. It also has an integrated insole, providing stability and support.
The Best Flip Flops for PTTD
As with dress shoes, while shopping for flip flops, keep in mind that a slight heel is ideal, as well as a rigid sole. Both of these provides for the control and stability that your foot needs with PTT Dysfunction.
Some of the best flip flops for Posterior Tibial Tendon Dysfunction in the market are:
1. Clarks Flip Flops: Specifically the Arla Marina Women’s Flip Flops. Its important to note that these flip flops have a heel height of 1.5 inches, almost 2 inches, which is great for stabilizing the PTTD foot. A unique feature is its flexible EVA outsole, a closed cell foam providing stability as well as cushioning.
2. The Gekadong Men’s Sandal is very popular and provides support, with a 1” heel, and is also “water friendly”.
3. The Vionic Unisex Wave Sandal, both for women, and men has a rubber sole for cushion and a 1” heel.
In recent years, more focus has been put on conservative treatments for PTTD. Many researchers and doctors alike have found that if caught early, PTTD can be treated and the symptoms resolved. More emphasis has been placed on conservative treatment options, rather than surgical, especially if the diagnosis is made in the first two stages of PTTD.
Conservative treatments include Orthotics or Inserts, which go into the shoes to support the arch and the PT tendon. Another conservative treatment is bracing, i.e. the Richie Brace which helps to support the entire ankle joint, as well as the medial arch, providing strength to the entire course of the PT tendon. Finally, footwear is extremely important for stability while ambulating on various types of terrain. A good pair of shoes will prevent further progression of the PT tendonitis, by providing support, shock absorption and decreasing the pronation forces on the foot