There are some diagnostic signs and tests that your podiatrist uses to determine if you have the condition, as well as how far the condition has advanced.
Pain along the course of the posterior tibial tendon is the most important sign when diagnosing PTTD. The posterior tibialis tendon wraps around the inside of the ankle and inserts on the arch. This allows the muscle to support the arch. If there is pain at the tendon’s insertion or pain when the doctor palpates the tendon as it goes up the leg, you may be experiencing PTTD. If there is no pain, PTTD is unlikely.
Assuming there is pain along the tendon, there are other tests that can be done to help confirm the diagnosis. The doctor will have the patient stand facing the wall. The doctor will stand directly behind the patient. Normally, the doctor can only see the 4th and 5th toes, with the leg covering the rest of the toes. In PTTD, when positioned behind the patient, the doctor will be able to see almost all of toes. This is known as the “too many toes” sign.
Another test your doctor will use to grade the amount of dysfunction is called the heel rise test. The doctor will have you stand next to the wall or counter for balance. You will then be asked to stand on your toes, first each foot individually, then both feet together. In someone with PTTD, this will illicit large amounts of pain in the arch and up the leg. In more advanced situations, the patient will not be capable of lifting their heels off the ground at all. Patients often are surprised that they didn’t notice their inability to lift up on their heels before their appointment.
Lastly, the doctor will watch you walk in the office. This is called gait analysis. The “too many toes sign” will be seen as they walk. The heel bone will not have normal movement, and the person will practically be walking on the inside of the foot, the arch being completely absent. The doctor will then correlate these findings to the x-rays taken in order to suggest the best treatment options. We’ll discuss some of those treatment options next week.