Posterior Tibial Tendon Dysfunction at Foot Foundation
Posterior Tibial Tendon Dysfunction (PTTD) is a progressive condition that weakens the tendon running along the inside of the ankle, leading to arch collapse and increasing ankle pain. Over time, this can develop into adult-acquired flatfoot and even ankle arthritis if left untreated.
Early management is key. At Foot Foundation, we focus on accurate diagnosis and tailored treatment to support the arch, strengthen the tendon, and restore stability. With specialist care, many patients can prevent progression and maintain an active lifestyle.
What is Posterior Tibial Tendon Dysfunction (PTTD)?
The posterior tibial tendon runs along the inside of the ankle, connecting the calf muscles to the arch of the foot. Its role is to support the medial longitudinal arch and stabilise the ankle during walking.
Posterior Tibial Tendon Dysfunction (PTTD) occurs when this tendon becomes overstretched, inflamed, or degenerative, leading to progressive collapse of the arch and increasing ankle pain. If untreated, it can progress to adult-acquired flatfoot deformity and ankle arthritis.
At Foot Foundation, we specialise in the early diagnosis and management of PTTD, preventing progression and restoring function through advanced rehabilitation, orthotics, and supportive therapies.
Causes & Risk Factors
Overuse – repetitive walking, running, or high-impact activity
Biomechanical strain – flat feet (pes planus), excessive pronation
Age-related degeneration – reduced tendon vascularity and elasticity
Previous ankle injuries – increasing load on the posterior tibial tendon
Obesity – increased load on the tendon and arch
Systemic conditions – diabetes, inflammatory arthritis
Poor footwear – inadequate arch support, worn-out shoes
Gender – more common in women over 40
Treatment at Foot Foundation
Custom orthotics – support the arch and reduce tendon strain
Ankle-foot orthoses (AFOs) – for advanced cases requiring external bracing
Footwear modification – supportive shoes with strong medial support
Exercise therapy – strengthening of tibialis posterior, intrinsic foot, and calf muscles
Manual therapy – improve mobility and reduce stiffness
Shockwave therapy (ESWT) – stimulate tendon healing in degenerative cases
Strapping or bracing – temporary relief and stabilisation
Weight management support – reduce load on tendon and joints
Referral for surgery – in severe or advanced cases (tendon transfer, osteotomy, or fusion procedures)
Symptoms
Pain and swelling along the inside of the ankle and foot
Flattening of the arch over time (progressive flatfoot)
Pain worsening with activity, particularly walking or standing for long periods
Inability to perform a single-leg heel raise on the affected side
“Rolling in” of the ankle (excessive pronation)
In advanced cases, pain may spread to the outside of the ankle due to joint strain
Stages of PTTD
Stage I: Mild tendon inflammation, no deformity
Stage II: Arch flattening begins, tendon elongates, ankle instability
Stage III: Rigid flatfoot deformity, arthritis may develop
Stage IV: Ankle joint involvement, severe deformity and arthritis
Diagnosis
At Foot Foundation, diagnosis is made through:
Clinical examination of tendon tenderness, arch collapse, and ankle alignment
Functional testing (single-leg heel raise, gait analysis)
Biomechanical assessment of pronation and load distribution
Imaging:
Ultrasound – tendon thickening, degeneration, or tears
MRI – detailed tendon evaluation and arthritis assessment
X-rays – in later stages to confirm deformity and arthritis
Contact us to learn more about Posterior Tibial Tendon Dysfunction treatment
If you are dealing with Posterior Tibial Tendon Dysfunction, our team can help you find the most suitable Foot Foundation clinic for assessment, diagnosis, and treatment support.
Whether your symptoms are affecting walking, standing, arch support, ankle stability, or daily comfort, we can guide you towards the right clinician and the right next step for your care.
To learn more about Posterior Tibial Tendon Dysfunction treatment and find the most suitable clinic for your care, use the links below:
Podiatrist pricing and availability
Pricing for Posterior Tibial Tendon Dysfunction assessment and treatment can vary depending on your consultation, the stage and severity of the condition, the treatment approach recommended, and whether ongoing podiatry or rehabilitation care is required.
Your Foot Foundation clinician will assess the tendon, arch position, ankle alignment, and overall function, then explain the most appropriate treatment plan based on your symptoms, activity level, and recovery goals.
To learn more about our podiatrists and current pricing, use the links below:
Posterior Tibial Tendon Dysfunction -
Frequently Asked Questions
What is Posterior Tibial Tendon Dysfunction?
Posterior Tibial Tendon Dysfunction is a condition where the tendon that supports the arch on the inside of the foot becomes weakened, stretched, or damaged. Over time, this can lead to arch collapse, ankle pain, and progressive flatfoot deformity.
What are the symptoms of Posterior Tibial Tendon Dysfunction?
Common symptoms include pain and swelling along the inside of the ankle, flattening of the arch, worsening pain with walking or standing, difficulty performing a single-leg heel raise, and a tendency for the foot to roll inward.
What causes Posterior Tibial Tendon Dysfunction?
PTTD is usually caused by overuse, age-related tendon degeneration, or biomechanical overload. Risk factors include flat feet, obesity, age over 40, previous ankle injuries, inflammatory arthritis, diabetes, and poor footwear.
How is Posterior Tibial Tendon Dysfunction diagnosed?
Diagnosis is based on clinical examination, functional testing, and imaging where needed. Your clinician may assess tendon tenderness, arch position, heel raise strength, gait, and ankle alignment. Ultrasound, MRI, or X-rays may also be used depending on the stage of the condition.
Can Posterior Tibial Tendon Dysfunction be cured?
In the earlier stages, PTTD can often be managed very effectively without surgery through orthotics, footwear modification, and rehabilitation. More advanced cases may require bracing or surgical opinion.
What is the best treatment for Posterior Tibial Tendon Dysfunction?
Treatment depends on severity, but often includes custom orthotics, supportive footwear, exercise rehabilitation, manual therapy, shockwave therapy in chronic tendon cases, and ankle-foot orthoses for more advanced stages.
Do orthotics help with PTTD?
Yes. Orthotics are one of the most effective treatments for PTTD because they help support the arch, reduce strain on the tendon, improve alignment, and slow progression of flatfoot deformity.
Can PTTD lead to arthritis?
Yes. If left untreated, Posterior Tibial Tendon Dysfunction can progress and lead to hindfoot or ankle arthritis, especially in more advanced stages where the deformity becomes more rigid.
Is surgery required for PTTD?
Surgery is not always needed. It is usually considered only in more advanced or severe cases that do not respond well to conservative treatment. Procedures may include tendon transfer, osteotomy, or fusion depending on the level of damage and deformity.
When should I see a podiatrist for ankle pain?
If you notice ongoing pain on the inside of the ankle, flattening of the arch, worsening walking tolerance, or difficulty balancing or pushing up onto the toes, it is best to seek assessment early.
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Our approach to Posterior Tibial Tendon Dysfunction
At Foot Foundation, our approach to Posterior Tibial Tendon Dysfunction begins with a thorough assessment to identify the stage of the condition, confirm the level of tendon involvement, and understand how arch collapse, biomechanics, and load are affecting your foot and ankle.
Once the diagnosis is confirmed, we create a personalised treatment plan focused on reducing tendon strain, improving arch support, restoring strength, and preventing further progression. Depending on your presentation, treatment may include custom orthotics, footwear modification, exercise therapy, manual therapy, shockwave therapy, strapping or bracing, and ankle-foot orthoses for more advanced cases. Where needed, we may also recommend imaging or referral for specialist surgical opinion.
Our goal is not only to reduce your current pain, but also to improve long-term foot and ankle function, protect the arch, and help you stay active with greater comfort and confidence.
