PTTD Symptoms: Recognizing the Warning Signs
Foot pain is easy to ignore. You might chalk it up to standing too long, wearing the wrong shoes, or just getting older. But certain patterns of pain and discomfort deserve attention—one of them is posterior tibial tendon dysfunction.
Here’s what to look for.
Early Warning Signs
PTTD doesn’t usually announce itself dramatically. It starts subtly:
- Aching along the inside of your ankle or foot after activity
- Mild swelling around the ankle that comes and goes
- Fatigue in your feet — they just feel tired faster than usual
- Pain that improves with rest but returns when you’re active again
These signs are easy to miss or dismiss. That’s the tricky part. Your body’s not screaming at you—it’s whispering. But these whispers are worth listening to.
Where It Hurts: Symptoms by Location
Inside of Foot and Ankle
This is the most common location for PTTD pain. You might feel it:
- Along the path of the posterior tibial tendon (running from behind your ankle down to the arch)
- Behind the medial malleolus—that bony bump on the inside of your ankle
- Deep in the midfoot area
The pain is often described as aching or throbbing, worse with activity and better with rest.
The Arch
As the tendon weakens, your arch starts to drop. You might notice:
- Your arch looking flatter than it used to
- Pain in the center of your arch, especially in the morning or after sitting
- A feeling like the bones in your foot are shifting
The Heel and Outside Ankle
Here’s the counterintuitive part: as your arch collapses, pain often shows up on the outside of your ankle. Why? Because when the arch falls, your heel rotates outward, changing how forces travel through your foot. That misalignment stresses the outside of your ankle.
Toe-Off Weakness
One hallmark symptom is weakness when trying to push off from your toes. You might notice:
- Difficulty standing on your toes, especially on just one foot
- A feeling that your foot isn’t “propelling” you forward normally
- Needing to modify your gait because you can’t push off effectively
This is a functional test you can actually do at home—try standing on your toes. If one foot is significantly weaker than the other, that’s worth noting.
Symptoms That Worsen Over Time
PTTD is progressive. That means symptoms tend to get worse, not better:
Early stage: Pain and swelling come and go. Your arch still looks mostly normal.
Middle stage: Pain becomes more constant. Your arch visibly flattens. You might start adjusting how you walk to avoid discomfort.
Later stages: Pain may shift to the outside of the ankle. Standing for long periods becomes uncomfortable. You might develop corns or calluses where pressure is now landing.
How PTTD Differs From Other Foot Problems
It helps to know what PTTD isn’t. Here’s how it stacks up against common foot conditions:
| Symptom | PTTD | Plantar Fasciitis | Achilles Tendonitis |
|---|---|---|---|
| Morning pain | Improves after walking | Worst at start | Stiffness along tendon |
| Pain location | Inside ankle/arch | Heel bottom | Back of heel |
| Standing on toes | Weak, difficult | Possible but painful | Weak, painful |
Of course, you can’t diagnose yourself with a table. But this gives you a sense of whether your symptoms fit the PTTD pattern.
Red Flags: When to See a Doctor
You should talk to a healthcare provider if:
- Pain persists for more than a few weeks
- Swelling doesn’t go away
- Your arch looks noticeably flatter
- You have difficulty with activities you used to do easily
- One foot feels significantly weaker than the other
- You have diabetes and notice any foot changes at all
Don’t wait for the pain to become severe. Earlier evaluation means more treatment options—and better outcomes.
What to Expect at Your Appointment
If you see a doctor about suspected PTTD, they will:
- Ask about your symptoms — when they started, what makes them better or worse
- Examine your foot — looking at your arch, how your heel sits, range of motion
- Test muscle strength — watching you stand on toes, checking push-off
- Possibly order imaging — X-rays, MRI, or ultrasound to see the tendon and bones
Bring shoes you wear regularly to the appointment—they can tell your doctor a lot about how your foot is functioning.
The Bottom Line
PTTD symptoms can be subtle at first, but they follow a recognizable pattern: aching along the inside of the foot and ankle, swelling, arch flattening, and weakness when pushing off. If these symptoms sound familiar, it’s worth getting evaluated. The condition is much easier to manage in its early stages.
Sources
- American Academy of Orthopaedic Surgeons (AAOS) - Posterior Tibial Tendon Dysfunction