Posterior Tibial Tendon Dysfunction: When the Arch Collapses

If you’ve noticed your foot arch gradually flattening or your ankle turning inward, you may be experiencing a condition called Posterior Tibial Tendon Dysfunction (PTTD) — one of the most common causes of adult-acquired flatfoot.

While it may start as mild ankle pain, PTTD can progress into significant deformity, affecting how you walk and stand. The good news? With early diagnosis and podiatric care, you can prevent long-term damage and restore healthy movement.

At Restore Foot & Ankle Specialists, we specialize in diagnosing and treating complex foot and ankle conditions like PTTD — helping patients regain strength, stability, and confidence with every step.

What Is Posterior Tibial Tendon Dysfunction (PTTD)?

The posterior tibial tendon is one of the most important stabilizers in your foot. It connects the calf muscle (tibialis posterior) to bones inside the foot, supporting your arch and helping you push off when walking.

When this tendon becomes inflamed, stretched, or torn, it can no longer hold the arch properly — causing it to gradually collapse. This leads to pain, weakness, and a noticeable change in foot shape.

Common Causes of PTTD

Posterior tibial tendon dysfunction often develops gradually over time due to overuse or chronic strain.

Major Causes Include:

• Overuse: Common in runners, hikers, and people who stand for long periods.

• Flat feet: Already place more strain on the tendon.

• Injury: A fall, twist, or impact to the ankle can damage the tendon.

• Age-related wear: The tendon can weaken and degenerate with time.

• Obesity or weight gain: Adds extra stress to the tendon.

• Inflammatory conditions: Like rheumatoid arthritis.

Women over 40 are particularly at risk, but PTTD can affect anyone who puts repeated strain on their feet and ankles.

Recognizing the Symptoms of PTTD

The symptoms of posterior tibial tendon dysfunction typically develop in stages, starting with pain and ending with visible arch collapse.

Early Symptoms:

• Pain and swelling along the inside of the ankle or foot

• Tenderness just behind the ankle bone (medial malleolus)

• Pain that worsens after activity or standing

• Difficulty standing on tiptoes

Progressive Symptoms:

• The arch begins to flatten

• The heel tilts outward

• The toes turn outward (“too many toes” sign when viewed from behind)

• Pain shifts to the outside of the ankle, where other joints begin to compensate

• Increasing difficulty walking or balancing

Without treatment, the condition can advance to rigid flatfoot and even arthritis in the ankle or hindfoot.

How Podiatrists Diagnose Posterior Tibial Tendon Dysfunction

A podiatrist can often diagnose PTTD through a physical exam and imaging studies.

During your evaluation at Restore Foot & Ankle Specialists, your doctor will:

• Examine your foot structure and gait

• Test tendon strength by asking you to stand on one foot or rise onto your toes

• Look for signs of arch collapse or heel tilting

• Order X-rays, ultrasound, or MRI to assess tendon damage and joint alignment

Early diagnosis is critical — the sooner treatment begins, the better the chances of preventing permanent deformity.

Treatment Options for PTTD

Treatment depends on the stage and severity of the condition. Mild to moderate cases can often be managed with conservative care, while advanced stages may require surgical correction.

Non-Surgical (Conservative) Treatments

1. Rest and Immobilization

Limiting activity and using a walking boot or brace allows the tendon to heal and reduces inflammation.

2. Custom Orthotics

Custom orthotics or ankle-foot orthoses (AFOs) help support the arch, reduce strain on the tendon, and improve foot alignment.

3. Physical Therapy

Stretching and strengthening exercises can restore flexibility and tendon strength. Physical therapy also improves balance and gait.

4. Medications and Ice

NSAIDs (nonsteroidal anti-inflammatory drugs) and ice therapy can reduce pain and swelling.

5. Supportive Footwear

Wearing shoes with good arch support, stability, and cushioning helps prevent progression.

Surgical Treatments (for Severe Cases)

If conservative methods fail or the deformity is advanced, surgery may be necessary to restore function.

Common surgical procedures include:

• Tendon Repair or Transfer: Repairing the damaged tendon or replacing it with another tendon from the foot.

• Osteotomy: Realigning bones to restore the arch.

• Arthrodesis: Fusing joints to stabilize the foot in severe deformities.

Surgical recovery may take several months but offers long-term correction and improved mobility when performed by an experienced podiatric surgeon.

Recovery and Rehabilitation

Recovery from PTTD — whether treated conservatively or surgically — requires patience and proper rehabilitation.

Key Tips for Successful Recovery:

• Follow your podiatrist’s instructions carefully.

• Wear supportive shoes or orthotics daily.

• Do prescribed stretches and strengthening exercises.

• Maintain a healthy body weight to reduce tendon strain.

• Return to physical activity gradually to avoid re-injury.

Most patients see significant improvement in pain and mobility with consistent treatment.

Preventing Posterior Tibial Tendon Dysfunction

You can reduce your risk of PTTD and protect your arches by:

• Wearing supportive footwear during activity.

• Using custom orthotics if you have flat feet or overpronation.

• Stretching and strengthening your calves and feet regularly.

• Avoiding sudden increases in activity levels.

• Managing weight and underlying health conditions.

The Bottom Line

Posterior tibial tendon dysfunction is more than just arch pain — it’s a progressive condition that can permanently alter your foot structure if ignored. But with early diagnosis, supportive treatment, and expert podiatric care, you can stop progression and stay active.

✅ At Restore Foot & Ankle Specialists, we provide advanced diagnostic imaging, custom orthotics, bracing, and minimally invasive surgical options to treat PTTD and restore healthy foot function. If your arch is collapsing or ankle pain is holding you back, contact our office today with Dr. Gireesh Reddy or Dr. Sirisha Pokala by calling (469) 573-3427 or by booking an appointment online.