What is posterior tibial tendon dysfunction?
Posterior tibial tendon dysfunction (PTTD) occurs when the posterior tibial tendon — one of the major supporting structures of the foot — becomes damaged or inflamed and loses its ability to hold up the arch. As the tendon weakens, the arch of the foot gradually flattens. PTTD is the most common cause of flatfoot that develops in adulthood, which is why it is often called adult acquired flatfoot.
The posterior tibial tendon runs from the calf, behind the inside of the ankle, and attaches along the bottom of the foot, where it helps support the arch and stabilize the foot with every step. When the tendon is overused or injured, it can stretch, become inflamed, or partially tear, and without this support the foot's structure begins to change over time.
What are the symptoms of posterior tibial tendon dysfunction?
Early PTTD typically causes pain and swelling along the inside of the foot and ankle, tracking the path of the tendon. As the condition progresses, the changes in foot shape become more noticeable. Common signs include:
- Pain, redness, warmth, and swelling on the inside of the foot and ankle
- An arch that appears to be flattening or has already flattened
- The front of the foot and toes turning outward
- The ankle rolling inward
- In later stages, pain shifting to the outside of the foot below the ankle as the bones begin to impinge
- Difficulty standing on the toes of the affected foot
What causes posterior tibial tendon dysfunction, and who is at risk?
PTTD is most commonly caused by chronic overuse of the posterior tibial tendon. Repetitive activities such as running, walking, hiking, and stair climbing put ongoing strain on the tendon, and over time this strain can lead to inflammation, degeneration, and tearing. The condition tends to develop gradually rather than from a single injury.
Because PTTD changes how the foot bears weight, it can also contribute to the arthritis and joint stress seen in conditions like flat feet and arthritis of the foot and ankle if it is not addressed.
How do we diagnose posterior tibial tendon dysfunction?
We diagnose PTTD with a physical examination that evaluates the shape of your foot, the strength of the posterior tibial tendon, and how you stand and walk. Your podiatrist will look for the classic signs of a flattening arch, outward-turning forefoot, and inward-rolling ankle, and will check for tenderness along the tendon's path.
Imaging such as X-rays, ultrasound, or MRI may be used to evaluate the extent of tendon damage and to check for related changes in the bones and joints. Identifying the stage of PTTD is important, because treatment options differ depending on how advanced the condition is.
How is posterior tibial tendon dysfunction treated?
Treatment for PTTD depends on how far the condition has progressed. Early-stage PTTD generally responds well to conservative care, while more advanced cases may require surgery to restore foot function.
Nonsurgical treatment
- Orthotic devices or ankle bracing to support the arch and reduce strain on the tendon
- Immobilization in a short-leg cast or walking boot to rest the tendon
- Physical therapy, including ultrasound therapy and rehabilitative exercises
- NSAIDs such as ibuprofen to reduce pain and inflammation
- Shoe modifications with built-in arch-support inserts
Surgery
Surgery becomes necessary when PTTD has progressed substantially or has failed to improve with non-surgical treatment. The specific procedure depends on the stage of the condition and may involve repairing or transferring a tendon, realigning bones, or fusing joints to restore stability. Our surgeons will discuss the most appropriate option for your stage of PTTD and your activity goals.
What is recovery from posterior tibial tendon dysfunction like?
Recovery from nonsurgical PTTD treatment often involves a gradual return to activity as pain and swelling improve, guided by ongoing use of orthotics or bracing and continued physical therapy to protect the tendon long term. Because PTTD tends to progress if untreated, sticking with your supportive footwear and activity modifications helps prevent the arch from flattening further.
If surgery is required, recovery is longer and typically includes a period of immobilization followed by supervised physical therapy to rebuild strength and restore normal walking mechanics. Our team will give you a personalized recovery timeline based on the specific procedure performed.
When should you see a podiatrist for posterior tibial tendon dysfunction?
See a podiatrist as soon as you notice pain or swelling along the inside of your ankle, or if you feel your arch beginning to flatten. PTTD is a progressive condition, and catching it early gives you access to more conservative treatment options and a better chance of avoiding surgery.
You should also seek evaluation if you notice your foot or toes turning outward, your ankle rolling inward, or new pain developing on the outside of your foot, as these can indicate the condition is advancing. You can request an appointment at either of our Northern Utah offices.
Why choose Wasatch Foot & Ankle Institute?
Wasatch Foot & Ankle Institute is a locally rooted podiatry practice serving Farmington, South Ogden, and the surrounding Davis and Weber County communities. Our board-certified, fellowship-trained physicians focus exclusively on the foot and ankle, giving us deep experience recognizing and treating PTTD at every stage.
That focus lets us offer the full spectrum of PTTD care under one roof — from custom orthotics and physical therapy to surgical reconstruction when it's truly needed — so your treatment can advance without a referral elsewhere. Learn more about our Farmington and South Ogden locations or call the office nearest you.
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 page is for general education and is not a substitute for an in-person evaluation.