Medical Issue

Posterior Tibial Tendon Dysfunction (PTTD)

Posterior Tibial Tendon Dysfunction (PTTD)

The posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot. Posterior Tibial Tendon Dysfunction (PTTD) occurs when the posterior tibial tendon becomes inflamed or torn behind the ankle or on the inside of the foot.

  • PTTD is often called adult-acquired flatfoot because it develops during adulthood.


PTTD is usually progressive, which means it keeps getting worse, especially if it is not treated early. Although the condition typically occurs in one foot, some people may develop it in both feet. PTTD initially causes pain on the inside of the foot and ankle, an area which may become red, warm and swollen. As PTTD advances, there may still be pain on the inside of the foot and ankle and the foot and toes will begin to turn outward as the ankle rolls inward. When PTTD becomes even more advanced, the arch flattens even more and pain may shift to the outside of the foot below the ankle. In moderate to severe cases, arthritis may also develop in the foot and the ankle.

Risk Factors

The risk for posterior tibial tendon dysfunction increases when playing high-impact sports, such as basketball, tennis or soccer, which cause micro-tears of the tendon from repetitive use. Once the tendon becomes too injured, the arch is likely to collapse over time. Posterior tibial tendon dysfunction is more common in women than men and in people over 40 years old. Additional risk factors include obesity, diabetes, and hypertension. People with severe pronation, extreme flat feet, are more likely to experience PTTD.


Posterior Tibial Tendon Dysfunction (PTTD) is caused by overuse of the posterior tibial tendon. Symptoms usually occur after activities that involve the tendon, such as running, walking, hiking or climbing stairs.


PTTD treatment varies based on the severity of the condition. Anti-inflammatory treatments are often recommended. For mild to moderate problems, options include orthotic devices, bracing, shoe modifications, or a short-leg cast to immobilize the foot and allow the tendon to heal. Physical therapy, ultrasound therapy and exercises may be used to help rehabilitate the tendon and muscle following immobilization.  For severe cases with advanced arthritis, surgery may be recommended

The Concierge Podiatry Advantage

At Concierge Podiatry we offer conservative treatments for PTTD starting with Perfect Posture Orthotics, custom fitted to restore arch function. A laser option can often shorten the healing time for many PTTD treatments. For more involved cases with partial tears of the posterior tibial tendon, a new biologic treatment option uses an injection of plasma rich protein (PRP), extracted from the patient's blood to repair a torn tendon without surgery. For the most challenging cases, a minimally invasive outpatient foot align surgical procedure is an option.

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