Preventing PTTD: Practical Strategies to Protect Your Posterior Tibial Tendon

Nobody thinks about their posterior tibial tendon until it starts causing problems. But this small tendon in your ankle does heavy lifting—literally—supporting your arch with every step you take. The good news? Most cases of PTTD are preventable with some smart habits and early attention to warning signs.

Who Is at Risk for PTTD?

Certain people face higher odds of developing posterior tibial tendon dysfunction:

  • Women over 40 — Hormonal changes and footwear choices play a role
  • Athletes — Runners, basketball players, tennis players, and dancers put repeated stress on the tendon
  • People with flat feet — Already compromised arch support increases tendon strain
  • Anyone overweight — Extra pounds mean extra load on your tendons
  • People with diabetes or rheumatoid arthritis — These conditions weaken connective tissues

If any of these apply to you, prevention becomes even more important.

Footwear Choices That Protect Your Tendons

Your shoes matter more than you might think. The wrong shoes force your posterior tibial tendon to work harder, while supportive shoes take pressure off it.

Look for these features:

  • Good arch support — This reduces strain on the PTT
  • Firm heel counter — The back of the shoe should hold your heel securely
  • Proper width — Shoes that cramp your toes change how you walk
  • Adequate cushioning — Impact absorption matters
  • Low to moderate heel — High heels put extra stress on the tendon

Replace shoes when the tread wears down or the support compresses. A good rule: swap running shoes every 300-500 miles, everyday shoes every 6-12 months depending on use.

Exercise Tips That Don’t Strain Your Tendons

Exercise is good for you—but the wrong type can hurt. Here’s how to stay active without damaging your PTT:

Safe activities:

  • Swimming — Zero impact, full body workout
  • Cycling — Low impact, strengthens calves gently
  • Elliptical machines — Controlled motion, reduced stress
  • Walking on flat surfaces — Start gradually if you’re new to exercise

Approach with caution:

  • Running — Build up slowly, replace worn shoes, avoid hard surfaces
  • High-impact sports — Basketball, tennis, volleyball put significant stress on the tendon
  • Deep squats — These load the tendon heavily

Stretching routine that helps:

  • Calf stretches held for 30 seconds, 2-3 times daily
  • Achilles tendon stretches
  • Toe spreads and marble pickups to strengthen intrinsic foot muscles

Weight Management Takes Pressure Off

Every extra pound translates to more force through your feet with each step. Losing even a small amount of weight can significantly reduce stress on your posterior tibial tendon.

If you’re overweight and active, focus on low-impact exercises while you work toward a healthier weight. Swimming and cycling let you burn calories without punishing your feet.

Early Warning Signs You Shouldn’t Ignore

Catching PTTD early makes treatment much simpler. Watch for:

  • Inner ankle pain — Especially after activity or upon waking
  • Swelling — Around the inside of your ankle
  • Flattening arch — One foot looking different than the other
  • Difficulty on tiptoes — Pain or inability to rise onto your toes
  • Foot fatigue — Feet that tire quickly or feel sore after short walks

If you notice any of these, it’s time to see a podiatrist or sports medicine doctor.

When to See a Doctor

Don’t wait for severe pain to get checked out. See a healthcare provider if:

  • Inner ankle pain lasts more than a few weeks
  • Swelling doesn’t improve with rest and ice
  • You’re having trouble with activities you used to do easily
  • One foot looks noticeably flatter than the other

Early intervention—orthotics, physical therapy, activity modification—can often stop PTTD before it progresses.

The Bottom Line

Preventing PTTD comes down to sensible habits: wear supportive shoes, maintain a healthy weight, exercise smart, and pay attention to early warning signs. Your posterior tibial tendon works hard for you every day—a little prevention goes a long way toward keeping it healthy.

Sources

  • American Academy of Orthopaedic Surgeons (AAOS) — Posterior Tibial Tendon Dysfunction information
  • Journal of Foot and Ankle Surgery — PTTD risk factors and prevention studies
  • American Podiatric Medical Association — Foot health and footwear guidance