Posterior Tibial Tendon Dysfunction

Understanding PTTD and Flatfoot

Learn how posterior tibial tendon dysfunction affects your arch and why early care matters.

What Is Posterior Tibial Tendon Dysfunction?

The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot.

PTTD is often called adult acquired flatfoot because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it is not treated early.

Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs. Symptoms may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle.

As the condition progresses, the symptoms change. When PTTD initially develops, there is pain on the inside of the foot and ankle along the course of the tendon, and the area may be red, warm, and swollen. Later, as the arch begins to flatten, the foot and toes begin to turn outward and the ankle rolls inward. In more advanced cases, the pain often shifts to the outside of the foot below the ankle, and arthritis may develop in the foot or ankle.

If you think you may be experiencing symptoms of PTTD, do not hesitate to call us or request an appointment online so we can evaluate the tendon and start you on the right treatment path.

Treatment Options for PTTD

Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery, and progression of your condition can be arrested. In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities.

In many cases of PTTD, treatment can begin with nonsurgical approaches, which may include:

Orthotic devices or bracing. To give your arch the support it needs, your doctor may provide you with an ankle brace or a custom orthotic device that fits into the shoe.

Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weightbearing for a while.

Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization.

Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.

Shoe modifications. Your doctor may advise changes to your existing shoes, recommend new shoes altogether, or prescribe special inserts designed to improve arch support.

In cases of PTTD that have progressed substantially or have failed to improve with nonsurgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Our doctors are well-versed in this condition and can develop an effective treatment course to get you back in action as soon as possible.