Posterior Tibial Tendon Dysfunction (PTTD)


What is posterior tibial tendon dysfunction or PTTD?

The posterior tibial tendon acts as one of the main supporting structures of the foot and aids in the function of the foot when walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon that limit its ability to support the arch of the foot. This results in the foot being flat.

PTTD is often called an „adult acquired flatfoot” because it is the most common type of flatfoot that develops in adulthood. Although this disease usually occurs in only one foot, some people can develop it in both feet. PTTD is usually progressive, which means that it will continue to get worse, especially if it is not treated promptly.


Overuse of the posterior tibial tendon is the most common cause of PTTD. In fact, symptoms usually occur after activities that involve the tendon, such as running, walking, cross-country walking, or climbing stairs.


Symptoms of PTTD may include pain, swelling, flattening of the arch of the foot, and an inward bent ankle. As the disease progresses, the symptoms change.

For example, when PTTD develops initially, there is usually pain on the inside of the foot and ankle (along the tendon). Also, the area may be red, hot, and swollen.

Then, as the arch begins to flatten, you may continue to have pain on the inside of your foot and ankle. But at this point, the foot and toes begin to curve outward from the ankle and the ankle bends inward.

As the PTTD progresses, the arch flattens even more and the pain often passes to the extreme side of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis can also develop in the ankle.

Non-surgical treatment

Due to the progressive nature of PTTD, early treatment is recommended. If treated early enough, your symptoms can be resolved without surgery and the progression of the disease can be stopped.

In contrast, untreated PTTD can leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations in walking, running, or other activities.

In many cases of PTTD, treatment can begin with non-surgical approaches that may include:

  • Orthopedic devices or support devices. To give the arch of your foot the support it needs, your foot and ankle doctor may instruct you to use a custom ankle support stirrup or orthotic device that fits inside your shoe.
  • Immobilization Sometimes a short leg cast or boot is used to immobilize the foot and allow the tendon to heal, or you may need to completely avoid putting weight on the foot for a time.
  • Physical therapy. Ultrasound therapy and exercises can help rehabilitate the tendon and muscle after immobilization.
  • Medication. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.
  • Shoe modifications. Your foot and ankle doctor can advise you to make changes to your footwear and may instruct you to use special insoles designed to improve arch support.

When is surgery needed?

In cases of PTTD that has progressed substantially or that has not improved with non-surgical treatment, surgery may be necessary. For some advanced cases, this may be the only option. Your foot and ankle physician will determine the best solution for your specific case.