From the clinic: a year later, pain-free and asking for another pair of orthoses

One of the most satisfying follow-up appointments is when a patient returns because treatment has worked so well that they want a second set.

This patient first came to see me in 2025 after her GP referred her for foot and ankle pain. An MRI had shown thickening where the tibialis posterior tendon attaches to the foot, alongside mild degenerative changes in the subtalar joint. Following examination and a functional assessment, I diagnosed posterior tibialis tendon dysfunction (PTTD).

The tibialis posterior tendon helps support and control the foot during walking. When it becomes painful, everyday activity can be affected, and treatment needs to address both the load on the tendon and the strength needed to manage that load.

The initial treatment plan

We took foam impressions to make custom, 3D-printed orthoses. I also recommended supportive Asics running shoes in place of her current trainers and prescribed a progressive exercise programme, starting with strengthening for the tibialis posterior tendon.

We discussed other options if symptoms persisted, including an injection for the arthritic subtalar joint. Surgery remained a possible later consideration, but our first step was to see how she responded to footwear, orthoses and rehabilitation.

At the early follow-up, four weeks after receiving the orthoses, she was already making good progress. I advised her to continue using them and to progress her exercises as the initial movements became easier. She was then able to manage her treatment independently.

The one-year follow-up

Around a year later, she returned with excellent news: she was pain-free. She was pleased enough with how the first pair of orthoses had worked that she wanted to purchase another set.

It is tempting to give all the credit to the insoles, but her treatment combined orthoses, suitable footwear and progressive exercise. The orthoses supported her foot while the exercise programme helped her build capacity. Her request for a second pair was a practical sign of how useful she had

found them in daily life.

PTTD should not always require an injection or surgery. In my caseload, almost all PTTD patients will have neither injection or surgery, with symptoms usually beginning to settle within as little as 4 weeks, a tailored non-surgical plan had achieved the outcome that mattered to her: being comfortable on her feet and able to get on with life without pain.

About the author

Mr Liam Stapleton MSc, PGCert, PGDip, FFPM RCPS(Glas), FRCPodM is an Advanced Practice Podiatrist Prescriber and Specialist in Podiatric Sports Medicine.

His postgraduate qualifications include Independent Prescribing, Musculoskeletal Ultrasound, Advanced Clinical Practice, the Theory of Podiatric Surgery and Podiatric Sports Medicine.

If foot or ankle pain is limiting your activity, you can book an assessment with Kent Sports Podiatry at one of our clinics across Kent.

Call: 01622 961005Book online: www.kentsportspod.com/online-booking