PTTD in women: gender-specific considerations

Posterior tibial tendon dysfunction doesn’t affect everyone equally. Studies consistently show women develop PTTD more often than men, and there are specific reasons why. Understanding these gender-specific factors can help you recognize risks and make better choices for your foot health.

Why PTTD affects women more

Several factors contribute to women having higher rates of PTTD:

Women tend to have more flexible feet and lower arches than men, which can mean less natural support for the posterior tibial tendon. High heels and flats both create problems—heels shift your weight forward, putting extra strain on the tendon, while flats offer little arch support. Many women wear one or both regularly. Women are also more likely to engage in activities like aerobics, dance, and yoga that can stress the posterior tibial tendon, especially with improper form or footwear. Some evidence suggests hormonal fluctuations—particularly estrogen and progesterone—may affect tendon flexibility and strength, which could explain why problems often emerge during pregnancy and menopause.

Hormonal considerations

Pregnancy and PTTD

Pregnancy brings a perfect storm for PTTD. Weight gain puts extra stress on the tendon. Hormones relax ligaments and tendons to prepare for childbirth, which can reduce foot stability. And many pregnant women naturally change their gait and standing patterns.

If you’re pregnant and notice inner ankle pain, don’t dismiss it as normal. Get evaluated—early intervention makes a big difference. Check our guide on PTTD and pregnancy for more details.

Menopause and bone density

Menopause brings hormonal changes that affect more than just bones. Tendons can become less resilient as estrogen levels drop. Combine this with any age-related bone density changes, and you have a recipe for increased PTTD risk.

Weight-bearing exercise, adequate calcium and vitamin D, and supportive footwear become even more important during and after menopause.

Footwear choices for women

Finding the right shoes is a constant balancing act for women with PTTD. Here’s the reality:

Avoid high heels over 2 inches—they force your foot into plantarflexion and strain the tendon. Steer clear of completely flat shoes with no arch support, like ballet flats or flip-flops. And toss worn-out shoes; they’ve lost their support.

Instead, look for heels 1 inch or lower with good arch support. Athletic shoes with motion control work well. Sandals with built-in arch support (like Vionic or Naot) are a solid choice, as are boots with ankle support.

It’s okay to have fashion shoes for special occasions—just don’t wear them for walking long distances or standing for hours.

Life stages and PTTD risk

In your 20s and 30s

Focus on prevention. Choose supportive footwear, strengthen your feet with exercises, and avoid overtraining. If you do high-impact fitness, progress gradually.

During pregnancy

Prioritize arch support. Consider compression socks, and don’t ignore ankle swelling or pain. Report symptoms to your doctor.

In your 40s and 50s

Pay attention to changes in your feet. If you notice your arches dropping or ankle pain increasing, get evaluated early. This is when PTTD often progresses.

During and after menopause

Maintain bone and tendon health through weight-bearing exercise, adequate nutrition, and consistent footwear support. Don’t assume foot pain is just part of aging.

The bottom line

Women face unique challenges with PTTD, but knowing the risks helps you act earlier. Pay attention to footwear, stay aware during hormonal changes (pregnancy, menopause), and don’t ignore symptoms. The earlier you address PTTD, the better your outcomes.

Sources

  • Clinical studies on gender differences in foot structure and tendon health
  • Research overview: PTTD epidemiology and risk factors
  • Guidelines on footwear and pregnancy-related musculoskeletal changes