Posterior Tibial Tendon Dysfunction (PTTD)

Also known as Adult-Acquired Flatfoot

Posterior Tibial Tendon Dysfunction (PTTD) is a progressive condition that affects the posterior tibial tendon, a key tendon that supports the arch of your foot. Over time, the tendon can become inflamed, stretched, or torn, leading to pain, flattening of the arch, and increasing foot deformity if left untreated.

Below are some of the key vascular conditions we assess and help manage:

What Causes PTTD?

PTTD is typically caused by:

• Overuse or repetitive stress on the tendon (e.g., in runners or athletes)
• Untreated tibialis posterior tendinitis
• Obesity or weight gain
• Flat feet or fallen arches
• Trauma or previous ankle injuries

This condition usually develops in adults over 40 and is more common in women.

Common Symptoms of PTTD

• Pain and swelling along the inside of the ankle and foot
• Flattening of the arch or progressive flatfoot deformity
• Difficulty walking, especially on uneven ground or stairs
• Ankle rolls inward (overpronation)
• Pain that worsens with prolonged standing or activity
• Loss of foot flexibility or stiffness

Podiatric Assessment for PTTD

A podiatrist will perform a comprehensive assessment to diagnose PTTD accurately and prevent the condition from progressing.

1. Patient History

• Timeline of symptoms and severity
• Past injuries or repetitive strain
• Activity level and footwear habits

2. Physical Examination

• Observation of foot alignment and arch structure
• Palpation of the posterior tibial tendon
• Single-leg heel raise test — patients with PTTD typically cannot complete this
• Checking for swelling, tenderness, and muscle weakness

3. Gait & Biomechanical Analysis

• Assessment of how you walk and stand to evaluate rolling in or flattening of the arch

4. Imaging

• X-rays to assess bone alignment and joint health
• MRI or ultrasound to check for tendon tears, degeneration, or inflammation

Treatment Options for Posterior Tibial Tendon Dysfunction

Early treatment can significantly slow or stop the progression of PTTD and avoid surgery.

Non-Surgical Treatments

• Rest and Activity Modification: Reduce impact activities like running or long walks
• Ice and Anti-inflammatory Medications: To relieve pain and inflammation
• Custom Orthotics: Provide proper arch support and correct abnormal foot mechanics
• Supportive Footwear: Shoes with good arch support and stability
• Ankle Braces or AFOs (Ankle-Foot Orthoses): For moderate cases to offload stress from the tendon
• Physical Therapy: Strengthening, stretching, and proprioceptive training
• Weight Management: Reducing pressure on the foot and ankle

Surgical Treatment

Surgery may be needed in severe or unresponsive cases and may include:

• Tendon repair or transfer
• Osteotomy (cutting and realigning bones)
• Joint fusion in advanced flatfoot deformity

When to See a Podiatrist

If you’re noticing progressive flattening of your arch, pain on the inside of your ankle, or difficulty walking, early intervention is critical. The earlier PTTD is treated, the more likely conservative care will be successful.

Early treatment can slow or stop progression & avoid surgery.

Call (07)  5338 7387 or  Book Online now.