What is Posterior Tibial Tendon Dysfunction?

Posterior tibial tendon dysfunction (PTTD) is one of the most common causes of pain and deformity in the adult foot. If you're reading this, you or someone you know is probably dealing with it right now.

The Simple Definition

Posterior tibial tendon dysfunction is a condition where the tendon that supports your arch gradually weakens and fails. This tendon—the posterior tibial tendon (PTT)—plays a critical role in holding up the arch of your foot.

When this tendon isn't working properly, your arch slowly collapses. That's why PTTD is the leading cause of adult-acquired flatfoot.

Anatomy: What We're Talking About

Your posterior tibial tendon runs along the inside of your ankle and attaches to the bones on the inside of your foot. Its main job:

• Supports the arch — Keeps your foot's natural curve intact
• Plays a role in walking — Helps you push off when stepping
• Stabilizes the hindfoot — Works with other tendons to keep everything aligned

This tendon takes a lot of stress—especially if you're on your feet a lot. Over time, that stress can add up.

What Actually Happens

Here's what goes wrong in PTTD:

1. The tendon becomes inflamed or damaged — This is often called tendonitis initially
2. The tendon weakens — It can't handle the same load it used to
3. The arch starts to collapse — Your foot flattens out
4. Other structures get stressed — Ligaments, joints, and other tendons compensate (and often hurt as a result)

The progression varies wildly. Some people notice it slowly over years. Others wake up one day with their foot dramatically flatter.

Common Causes

PTTD doesn't have one single cause. It's usually a combination of factors:

• Age — Most common in people over 40
• Repetitive stress — Longstanding walking, running, or standing
• Previous injuries — Twisted ankles, fractures
• Obesity — Extra weight stresses the tendon
• Diabetes — Can weaken connective tissues
• Hypertension — Associated with tendon problems
• Certain sports — Running, tennis, basketball place high demands on the tendon

Women are affected more often than men, and it's frequently seen in people who are on their feet for work.

Symptoms: What to Watch For

PTTD doesn't always announce itself loudly at first. Watch for:

Early Signs

• Pain along the inside of the ankle — Especially during or after activity
• Swelling — Along the tendon, often more noticeable after activity
• Weakness — Difficulty standing on tiptoes on the affected side
• Foot fatigue — Feet that tire out faster than they used to

Progressing Symptoms

• Arch collapsing — Visible flattening of the foot's natural curve
• Heel drifting — The heel bone tilts outward
• Outer ankle pain — As the foot misaligns, the outside of the ankle takes stress
• Change in gait — Walking differently to compensate for the pain

Advanced Symptoms

• Severe flatfoot — Complete loss of arch
• Arthritis — Joint damage from long-term misalignment
• Significant disability — Trouble walking or standing for any length of time

How It's Diagnosed

If you think you might have PTTD, here's what to expect at the doctor's:

1. Physical exam — Your doctor will check for swelling, pain points, and foot alignment
2. Single heel rise test — Asked to stand on one foot and lift your heel. Hard to do with PTTD.
3. Gait analysis — Watching how you walk
4. Imaging — X-rays show bone alignment; MRI or ultrasound shows tendon damage

Getting diagnosed early matters. The sooner you catch it, the easier it is to manage.

Why Early Action Matters

Here's the honest truth: PTTD is progressive. Without treatment, it almost always gets worse over time.

The good news? Early stages respond very well to conservative treatment. Many people never need surgery if they address it early.

That's why understanding the stages of PTTD is so important—it helps you know where you stand and what to do about it.

Treatment: The Road Ahead

Treatment depends heavily on what stage you're in. Options include:

• Rest and activity modification — Giving the tendon time to heal
• Supportive footwear — Shoes that actually support your arch
• Orthotics — Custom inserts that do the tendon's job
• Physical therapy — Exercises to strengthen what's weakened
• Medications — NSAIDs for pain and inflammation
• Surgery — For advanced cases

We cover all this in detail on our Treatment Options page.

What You Can Do Right Now

If any of this sounds familiar:

1. Stop ignoring the pain — It's not going to away on its own
2. Get proper shoes — Skip the flats, flip-flops, and worn-out sneakers
3. Ease up on aggravating activities — If it hurts, don't push through
4. Learn the exercises — Our exercises guide has evidence-based moves
5. See a professional — Podiatrist, orthopedist, or sports medicine doctor