Posterior tibial tendon dysfunction (PTTD) develops when the tendon running along the inside of your ankle — the one that supports your arch with every step — becomes overworked, inflamed, or torn. Left untreated, it can lead to a progressively flattening arch, a shifted heel, and eventually a permanent change in the shape of your foot. Caught early, though, it's often manageable with supportive footwear, orthotics, and targeted strengthening.
Because PTTD develops gradually, many patients don't recognize it until the arch has already started to change. Our podiatrists in Farmington and South Ogden walk through what causes it, the signs to watch for, and the everyday steps that help protect this hardworking tendon.
What is the posterior tibial tendon, and what does it do?
The posterior tibial tendon runs along the inside of the ankle and attaches to bones in the midfoot. Its job is to stabilize the foot and support the arch while you walk, run, or stand. When the tendon is repeatedly overworked or injured, it gradually loses the strength to do that job — and the arch that depends on it can begin to flatten.
What causes PTTD, and who is at risk?
PTTD usually develops from a combination of repetitive strain and factors that weaken the tendon over time. Common contributors include:
- Repetitive high-impact sports or activities that load the tendon over and over
- Trauma from an ankle injury or fall
- Obesity, which adds ongoing strain to the tendon
- Diabetes and hypertension, which can affect tendon and tissue health
- Pre-existing flat feet, which change how load is distributed through the tendon
- Middle age, when tendons naturally lose some of their strength and elasticity
What are the signs and symptoms of PTTD?
Early indicators include pain and swelling along the inside of the ankle, a noticeable flattening of the arch, and difficulty standing up on your toes on the affected side. As the condition progresses, symptoms can shift to the outside of the ankle as the joint compensates and strains differently, along with uneven wear on the outside of your shoes and increasing difficulty walking.
How can you help prevent PTTD?
Because PTTD develops gradually, consistent preventive habits make a real difference — especially if you already have flat feet or a physically demanding routine. We recommend:
- Supportive footwear with strong arch support and a firm heel counter
- Custom orthotics to distribute pressure evenly across the foot — see our custom orthotics options
- Weight management to reduce the ongoing strain on the tendon
- Strengthening exercises such as calf raises, resistance band work, and arch lifts
- Balance training to improve proprioception and joint stability
How is PTTD treated?
Many cases can be managed conservatively, especially when caught early. A typical plan combines rest, ice, and anti-inflammatory medication with supportive bracing and physical therapy targeting the tendon — including strengthening exercises, balance training, flexibility work, manual therapy, and taping techniques. More advanced or long-standing cases may require a custom brace, and severe cases that don't respond to conservative care may need surgical tendon repair or reconstruction.
Everyday habits that support tendon health
Beyond specific exercises, a few lifestyle habits support tendon health generally: low-impact cardio like swimming or cycling instead of high-impact activities, proper warm-ups and stretching before exercise, adequate rest between hard training sessions, a diet with enough protein, calcium, and vitamin D, staying well hydrated, and avoiding smoking, which impairs tissue repair.
Why early evaluation matters
PTTD tends to progress if it's ignored, and an arch that has already flattened significantly is much harder to correct than one caught early. See a podiatrist if you notice pain or swelling on the inside of your ankle, a change in your arch, or difficulty standing on your toes. When you're ready, you can request an appointment at either of our Northern Utah offices.
Medically reviewed by the physicians at Wasatch Foot & Ankle Institute. Our board-certified, fellowship-trained podiatrists provide foot and ankle care in Farmington and South Ogden, Utah. This article is for general education and is not a substitute for an in-person evaluation.