PTTD and diabetes: managing both conditions
Diabetes affects every part of your body, and your feet take a beating. If you have diabetes and notice inner ankle pain or arch collapse, you might be dealing with PTTD on top of everything else. This combination needs special attention—diabetics face higher risks and different challenges than non-diabetics with this condition.
The diabetes-PTTD connection
Diabetes is a significant risk factor for developing PTTD. Here’s why:
High blood sugar affects collagen in tendons, making them stiffer and less able to handle stress. Over time, this can lead to degeneration. Diabetic neuropathy numbs your feet—you might have PTTD progressing without feeling the pain that would normally alert you to a problem. By the time you notice something’s wrong, the damage may be advanced. Diabetes also impairs blood flow, especially to the extremities. Reduced blood supply means tendons don’t heal as well and are more prone to injury. And many people with diabetes carry extra weight, which stresses the posterior tibial tendon even more.
Unique challenges for diabetics
If you have diabetes, PTTD presents some specific challenges:
You might not feel the early warning signs. That dull ache behind your ankle that would send someone else to the doctor? You might feel nothing until the tendon is significantly damaged.
Wound healing is slower. If you develop blisters, ulcers, or need surgery, your body takes longer to recover. This means any foot problem needs to be taken seriously.
Infection risk is higher. Even small cuts can become serious infections in diabetic feet. PTTD can change your foot shape, creating pressure points where ulcers form.
Warning signs to watch for
Since pain might not be a reliable indicator, look for these other signs:
- Swelling around the inner ankle that won’t go down
- A visible change in your arch (it looks lower or has collapsed)
- Difficulty walking or a change in your gait
- Warmth or redness along the tendon path
- A feeling of tightness in your arch or calf
If you notice any of these, see a podiatrist. Don’t wait for pain.
Prevention matters more for diabetics
- Check your feet every day. Look for swelling, redness, blisters, or changes in skin color.
- Wear supportive shoes designed for diabetics. Never go barefoot, even indoors.
- Control your blood sugar. Better glucose control means healthier tendons.
- Maintain a healthy weight. Less pressure on your feet.
- Stay active, but choose low-impact exercise. Swimming and cycling are easier on your feet than running.
Treatment considerations
Treatment for PTTD in diabetics requires extra caution:
Conservative approaches like orthotics, braces, and physical therapy are often tried first. But because diabetic tissue doesn’t heal as quickly, your doctor may be more cautious about progression.
Surgery is higher risk for diabetics. If you need surgical intervention, expect a longer recovery and more careful monitoring. Your surgeon will want to make sure your blood sugar is well-controlled before and after any procedure.
Never self-treat diabetic foot problems. Anything more than minor care should involve your podiatrist or healthcare provider.
When to seek care urgently
Contact your doctor immediately if you notice:
- Any open sore or ulcer on your foot
- Signs of infection (redness, warmth, pus, fever)
- Sudden swelling or severe pain
- Black or discolored toes
- Any foot injury, no matter how small
With diabetes, what seems minor can become major quickly. When in doubt, get checked out.
The bottom line
Diabetes and PTTD together require vigilance. Check your feet daily, don’t ignore swelling or shape changes, and see a podiatrist regularly. The earlier PTTD is caught, the easier it is to manage. Work with your healthcare team—your endocrinologist, podiatrist, and anyone else managing your diabetes—to keep your feet healthy.
Sources
- Clinical research on diabetes and tendon health
- Guidelines for diabetic foot care and PTTD management
- Evidence on neuropathy and delayed symptom recognition in diabetics