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  • Align Health Collective | Physiotherapy

What is Posterior Tibial Tendon Dysfunction?

Updated: Oct 3

Posterior Tibial Tendon Dysfunction (PTTD) is a condition that impacts the ankle and foot, leading to pain, deformity, and limitations in mobility. It is the leading cause of adult-acquired flatfoot deformity. If you’ve been experiencing foot or ankle pain or have had trouble walking and running, you could be suffering from PTTD.

In this article, we’ll explore what exactly PTTD is, its symptoms, causes, and treatment options, as well as prevention tips. If you're seeking expert care, consider visiting us at Podiatrist Indooroopilly in Brisbane, or if you're in Melbourne, our Podiatrist Kew and Podiatrist Oakleigh clinics are ready to assist you with the expertise you'll need.

What is PTTD?

Let’s start with a look at the posterior tibial tendon. This tendon is a critical component of the foot's anatomy. Origin

ating from the posterior tibial muscle in the calf, this tendon runs along the inside of the ankle and attaches to the bones on the inside of the foot. The primary functions of the posterior tibial tendon are supporting the arch of the foot and providing stability when we walk and run.

So, when this tendon is damaged or inflamed, it results in dysfunction: PTTD. This condition, also referred to as posterior tibial tendon insufficiency, can lead to adult acquired flatfoot (aka, flat foot), where the arch of the foot collapses.


Healthline notes that some activities are more likely to result in an injured posterior tibial tendon, so care should be taken when engaging in high-impact sports, such as tennis, football, basketball, and long-distance running. Other risky activities include climbing stairs and hiking. Moreover, Healthline indicates that females as well as individuals aged 40 and older are more prone to develop PTTD.

Additionally, several risk factors contribute to the development of PTTD. These include obesity, hypertension, and diabetes. Additional factors like ageing, repetitive stress injuries, and previous trauma to the foot or ankle can also increase the risk. If necessary, your podiatrist will recommend lifestyle changes such as weight management, regular exercise, and controlling blood sugar and blood pressure levels to help mitigate these risks.


Common symptoms of PTTD include:

  • feeling weak or as if you cannot support body weight on your ankle or foot

  • pain, swelling, or tenderness along the inside of the foot and ankle

  • Pain and inflammation is often worse in the morning

  • swelling along the inside of the shin or back of the calf

  • swollen ankle (could be mistaken for a sprained ankle)

  • difficulty walking or running

  • difficulty lifting heel or standing on toes/tiptoes

  • limited mobility

  • foot deformity.

What is Posterior Tibial Tendon Dysfunction (PTTD)?

If left untreated, PTTD can quickly worsen and may eventually require surgical intervention, while early diagnosis almost always results in non-surgical treatment. Untreated PTTD often results in painful foot and ankle arthritis, while the pain will increase and can even spread all the way up to the knee and hip area. Your gait and everyday movements can also be affected.

So, if you have been experiencing any of the symptoms above, seek advice from a qualified healthcare professional as soon as you can.

Stages of PTTD

PTTD progresses through various stages, each with its own set of symptoms and treatment options. Understanding these stages can help to effectively manage PTTD.

Stage 1

At this stage, the tendon is injured or stretched but still intact. Symptoms include mild pain and swelling along the inside of the foot and ankle. You’ll often experience more pain in your instep when walking or running. You will still be able to stand on the affected foot at this stage.

Stage 2

Stage 2 PTTD is generally categorised by a partially torn tendon. This will lead to more pain and limited mobility. At this stage, the arch of the foot may begin to collapse (meaning your foot may look flatter than what is typical), and simple activities like walking can become challenging.

Stage 3

At this stage, the tendon is completely torn. This results in severe deformity and flatfoot. The heel will not be flexible any more, mobility is significantly restricted, and surgical intervention is often required to remedy the condition and relieve pain. The cartilage in your ankles may also be worn down, eventually resulting in very painful osteoarthritis.

Stage 4

This is the most severe stage, where degenerative changes occur in the ankle joint itself, often leading to arthritis. The ankle may start to tilt down and inwards, while the toes may start to point outwards instead of pointing straight.

Foot Pain caused by Posterior Tibial Tendon Dysfunction


Your podiatrist will go through your medical history, conduct a thorough physical examination of your foot, ankle, and calf, and discuss any changes you’ve experienced in your foot. Your podiatrist will check your range of motion, any swelling along your foot and ankle, as well as your ability to stand on your tiptoes.

Diagnostic tests such as X-rays, MRIs, CT scans, and ultrasounds are often used to confirm whether the patient has PTTD. These tests can reveal the extent of tendon damage and help in determining the stage of the condition, which is crucial for planning the appropriate treatment.

Treatment Options

Non-Surgical (Conservative) Methods

  • Depending on the severity of your PTTD, your treatment will likely involve rest, ice, and anti-inflammatory medications, such as ibuprofen. Immobilisation is also an important part of treatment, as your tendon and surrounding areas need rest and time to heal.

  • Custom-made orthotics and shoe inserts are often used to support the arch and relieve pain. You may also be prescribed an ankle brace or temporary boot to aid with immobilisation and pain management.

  • Exercises will strengthen the foot and ankle muscles (such as the tibialis anterior muscle) are also recommended, especially in the early stages of PTTD. Physical therapy and certain stretches can also help to relieve pain.

Surgical Methods

Surgical intervention is considered a last resort and is usually recommended for the later stages of PTTD and very severe cases, which could not be treated effectively non-surgically. Surgical options may include tendon transfers, osteotomies (cutting and reshaping the bones around the foot), and fusions to realign the foot and restore your foot and ankle’s function.

Early Intervention and Prevention

Early detection and treatment are essential to prevent PTTD from progressing to more severe stages. Preventive measures include lifestyle changes such as weight management and regular exercise. Stretching your calf muscles, doing strengthening exercises, and wearing correct, supportive shoes, can often prevent PTTD from developing. Moreover, monitoring your symptoms and seeking medical advice at the earliest signs of discomfort can go a long way in managing this condition effectively.

Get in touch

At Align Health Collective, we are committed to giving our patients the utmost care and support from the moment they come in for a consultation until they receive a definitive diagnosis because we know how difficult it can be to live with PTTD.

We cannot overstate the importance of early diagnosis, as over time, PTTD can progress to more severe stages. Our team of experts tailors each treatment to each client’s individual needs, so no matter the severity of your PTTD, we can develop a treatment plan for you.

We provide a variety of reliable, efficient PTTD treatment methods, including manual therapy, exercise therapy, and orthotics. We also provide guidance on home remedies and preventative strategies to help you manage your symptoms and avoid harm in the future.

Contact us at our offices in Melbourne, VIC or Brisbane, QLD, today to book your consultation and take the first step towards recovery.

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