Understanding Posterior Tibial Tendon Dysfunction (PTTD)

Posterior Tibial Tendon Dysfunction—often called PTTD or adult-acquired flatfoot—is a common condition that affects the tendon on the inside of your ankle. This tendon plays a major role in supporting the arch of your foot and helping you walk normally. When it becomes inflamed or damaged, your arch may collapse, leading to pain, instability, and difficulty with daily activities.

PTTD can range from mild tendon irritation to significant deformity. Recognizing the symptoms early and getting proper treatment can greatly improve long-term outcomes.

What Does the Posterior Tibial Tendon Do?

The posterior tibial tendon runs from the calf, behind the inside ankle bone, and attaches to the bones on the inside of the foot. Its main responsibilities include:

• Supporting the arch of the foot
• Helping stabilize the ankle
• Assisting with walking, especially when pushing off the ground

When the tendon weakens or tears, the arch loses support, and the foot gradually turns inward.

What Causes PTTD?

PTTD typically develops from overuse, injury, or age-related changes. Common causes include:

1. Overuse Injuries

Activities that involve repetitive impact, such as running, hiking, or high-impact sports, can strain the tendon over time.

2. Trauma

A fall or ankle injury can cause a sudden tear or worsen an existing tendon problem.

3. Age-Related Changes

Tendons naturally lose elasticity and strength as we age, making middle-aged adults particularly susceptible.

4. Contributing Risk Factors

Certain conditions increase the likelihood of developing PTTD, including:

• Obesity
• Diabetes
• High blood pressure
• Flatfoot deformity
• Previous foot or ankle injuries

Common Symptoms

PTTD symptoms usually begin gradually and worsen over time. You may notice:

• Pain and swelling along the inside of the ankle
• Difficulty standing on your toes
• A flattening of the arch
• The foot rolling inward
• Pain that worsens with activity, especially walking or climbing stairs
• Trouble fitting into shoes due to swelling or deformity

As the condition progresses, pain may also develop on the outside of the ankle, where other joints are placed under stress from the altered foot position.

How Is PTTD Diagnosed?

An orthopedic specialist will evaluate:

• Your medical history and symptoms
• Foot alignment and arch height
• Strength and flexibility of the posterior tibial tendon
• Your ability to stand on one foot or rise onto your toes

Imaging tests such as X-rays, MRI, or ultrasound may be used to assess tendon damage and joint alignment.

Treatment Options for PTTD

Treatment depends on the severity and stage of dysfunction. Many patients improve with early, nonsurgical care, but advanced cases may require surgery.

Nonsurgical Treatments

• Rest and activity modification: Reducing activities that aggravate symptoms helps the tendon heal.
• Immobilization: A walking boot or brace may be recommended to protect the tendon during healing.
• Custom orthotics or ankle braces: These support the arch and reduce stress on the tendon.
• Physical therapy: Strengthening, stretching, and balance exercises restore function and relieve pain.
• Anti-inflammatory medications: NSAIDs can help reduce pain and swelling.
• Weight management: Reducing excess body weight can significantly lessen strain on the tendon.

Surgical Treatments

If conservative treatment isn’t effective, especially in later stages, surgery may be recommended. Procedures may include:

• Tendon repair or reconstruction
• Realignment procedures to correct deformity
• Joint fusion for severe arthritis or advanced collapse

Your surgeon will develop a treatment plan tailored to your condition and activity goals.

When to Seek Medical Care

Persistent pain along the inside of the ankle, especially if accompanied by arch changes, shouldn’t be ignored. Early evaluation leads to better recovery and reduces the likelihood of needing surgery.

If you’re experiencing symptoms of PTTD, a foot and ankle specialist can help you understand the cause of your pain and recommend the most effective treatment options.