What is Posterior Tibial Tendon Dysfunction?
Posterior tibial tendon dysfunction (PTTD) is a progressive condition affecting the tendon that runs along the inside of the ankle. This tendon is crucial for supporting the arch and controlling foot motion during walking.
When the tendon becomes damaged or inflamed, the arch gradually collapses, leading to adult-acquired flat foot. Early treatment is essential to prevent progression and avoid the need for surgery.
Common Symptoms
- Pain and swelling along the inner ankle
- Gradual flattening of the foot arch
- Difficulty standing on tiptoes
- Pain that worsens with activity
- Ankle turning outward
- Pain on the outside of the ankle (later stages)
Common Causes
- Overuse and repetitive strain
- Acute injury to the tendon
- Obesity and increased body weight
- Inflammatory conditions (rheumatoid arthritis)
- Diabetes
- Age-related degeneration
- Previous steroid injections near the tendon
How We Treat Posterior Tibial Tendon Dysfunction
PTTD is staged I-IV based on severity. Early-stage disease responds well to conservative treatment. Our goal is to support the foot, reduce tendon strain, and prevent progression to more severe stages that may require surgery. Supporting the arch with 3D-printed orthotics is central to offloading the tendon in early-stage PTTD. For more advanced stages, a Richie brace or custom AFO provides the extra stability needed to keep you walking.
Custom Orthotics/AFO
Immobilisation
Strengthening Exercises
Footwear Modification
Ready to get posterior tibial tendon dysfunction treated?
When to Seek Professional Help
- Pain along the inside of your ankle
- Your arch seems to be getting flatter
- You can't stand on tiptoes on one foot
- Ankle or foot pain is affecting your walking
- Previous treatments haven't helped
Frequently Asked Questions
Common questions about Posterior Tibial Tendon Dysfunction at Lower Limb Clinic.
Clinically reviewed by Paul McMullan, BSc(Hons) MSc FRCPSGlasg MRCPod
BSc (Hons) Podiatry · MSc Podiatric Sports Medicine (QMUL) · FRCPSGlasg · MRCPod
Lead Podiatrist & Clinical Director, Lower Limb Clinic Belfast