Bunions vs. Posterior Tibial Tendon Dysfunction: Foot Pain Symptoms and Treatment

Your feet carry you through every part of your day, from the morning walk to a long shift on your feet. When they start to hurt, it can affect how you walk, what shoes you can wear, and how active you want to be.

Two common sources of foot pain are bunions and posterior tibial tendon dysfunction (PTTD). Both can make standing and walking uncomfortable and both tend to get worse over time if they aren't treated, but they affect different parts of the foot and are treated in different ways.

What is a Bunion?

A bunion is a bony bump that forms at the base of the big toe. Over time, the big toe starts to lean toward the second toe, which pushes the joint at the base of the toe outward. The bump can rub against shoes and become sore, red, and swollen.

Bunions usually develop slowly. Shoes that are tight or narrow in the toe can make them more painful, and in more severe cases arthritis can develop in the joint. Common symptoms include:

• A Visible Bump: A bony bump on the inside of the foot at the base of the big toe.
• Pain in Shoes: Soreness, rubbing, or redness where the bump presses against your shoe.
• A Shifting Big Toe: The big toe angles toward or crowds the smaller toes.
• Stiffness: Less movement in the big toe joint, which can make walking uncomfortable.

What is Posterior Tibial Tendon Dysfunction?

The posterior tibial tendon runs along the inside of the ankle and into the foot. Its main job is to support the arch. When the tendon becomes inflamed or damaged, it can't support the arch as well, and the result is pain known as posterior tibial tendon dysfunction. It's one of the most common conditions foot and ankle specialists treat.

PTTD is usually caused by inflammation from an injury or overuse. People who do a lot of running and jumping are at higher risk. Common symptoms include:

• Pain Along the Tendon: Pain along the inside of the ankle and arch, where the tendon runs.
• Worse with Activity: Pain that builds with exercise, walking, or standing for long periods.
• Swelling: Swelling along the inside of the ankle.
• Changes in the Arch: As the tendon weakens, the arch may lose support and the foot can start to flatten.

Key Differences Between Bunions and PTTD

The location of your pain is the biggest clue. Bunion pain is centered at the base of the big toe, and you can usually see the bump. PTTD pain is felt along the inside of the ankle and arch, and it often doesn't come with a visible bump.

What makes the pain worse is another clue. Bunions tend to hurt most when shoes press on the joint. PTTD tends to hurt most after long periods of standing, walking, or exercise. Because foot problems can overlap, a foot and ankle specialist will do a thorough exam and may order imaging to confirm the cause and rule out other problems.

Treatment Options for Foot Pain

Most bunions and many cases of PTTD can be managed without surgery. Depending on your condition, nonsurgical treatment may include:

• Rest and Ice: Cutting back on high-impact activity and long periods of standing gives inflammation a chance to settle down.
• Shoes and Inserts: Supportive shoes and inserts can cushion the foot, take pressure off a bunion, and support the arch.
• Temporary Immobilization: For PTTD, a cast, splint, or walking boot can rest the tendon so it can heal.
• Anti-Inflammatory Treatment: Topical anti-inflammatory medications or steroid injections can calm pain and swelling.
• Physical Therapy: Stretching and strengthening exercises improve flexibility and support the foot and ankle.

When pain doesn't improve with these treatments, surgery may be an option. For bunions that are severe and change the shape and function of the foot, bunion surgery can realign the big toe joint, often by reshaping the bone and tightening or loosening the surrounding soft tissue. For PTTD, surgical options include lengthening a tight calf muscle or Achilles tendon, removing inflamed tendon tissue, transferring a healthy tendon to take over for the damaged one, or reshaping the bones of the arch. Your surgeon will recommend the procedure that best fits your foot and your goals.

Taking the Next Step

Foot pain is common, but it isn't something you have to live with. The foot and ankle specialists at Orthopedic Specialists of Northwest Indiana can find the source of your pain and walk you through every option, from supportive shoes and physical therapy to surgery when it's needed. Call (219) 924-3300 or request an appointment online to get started.