A person with post tibialis tendon dysfunction trying to go up onto tip toes and failing

PTTD – Posterior Tibial Tendon Dysfunction

What is Posterior Tibial Tendon Dysfunction (PTTD)?

Posterior Tibial Tendon Dysfunction (PTTD) is a condition that affects the tendon that connects the calf muscle to the bones in the foot. 

This tendon helps to support the arch of the foot and allows for normal walking and running motions. 

PTTD can occur when the tendon becomes weakened or stretched, often as a result of overuse or injury.

In some cases, PTTD may also be caused by anatomical problems, such as flat feet as you can see in the photo to the right. 
This foot has no arch now as the tendon has failed.

A close up photo of a left foot which has a totally collapsed arch from PTTD

Symptoms of Posterior Tibial Tendon Dysfunction include pain and swelling along the inside of the ankle and foot, difficulty bearing weight on the affected foot, and an inward rolling of the foot (known as pronation).

 PTTD is generally treated with a combination of rest, ice, and physical therapy. In severe cases, surgery may be necessary to repair or replace the damaged tendon.

What are the Symptoms of PTTD?

PTTD, or Posterior Tibialis Tendon Dysfunction, is a condition that affects the tendons in the foot and ankle. 

The tendon becomes inflamed and irritated, which can lead to pain and swelling. 

PTTD can also cause the foot to become flat and pronated, or turn inward. In severe cases, the tendon may rupture, which can require surgery to repair.

What are the Treatment Options for Posterior Tibial Tendon Dysfunction?

Treatment for PTTD in the early stages often begins with conservative measures such as rest, ice, and physical therapy. 

Custom foot orthotics or other arch supports are usually prescribed to take tension off the damaged tendon.

If these measures do not improve symptoms, surgery may be necessary to repair or replace the damaged tendon. 

With proper treatment, PTTD can be effectively managed and patients can experience significant relief from symptoms.

Orthotics in the Treatment of PTTD

Custom orthotics are usually THE most effective conservative (non-surgical) treatment method to reduce pain, and take tension of the tendon preventing it from getting worse.

To the right is a photo of a foot being well supported by a custom foot orthotic.

A right foot standing on a custom orthotic insole which is supporting the arch.


Because the Tibialis Posterior muscle (and tendon) is the main muscle responsible for supporting the arch, the foot will tend to collapse through the arch during Posterior Tibial Tendon Dysfunction which only leads to further development of the problem and more pain.

By using custom foot orthotics we get an exact replica of your feet and make supportive insoles that will hold your foot in the best position to support you when standing, walking and running. See our post on custom foot orthotics here.


Can Posterior Tibial Tendon Dysfunction be Prevented?

There are several things that can be done to help prevent PTTD from occurring in the first place including the following:

  •  maintain a healthy weight – excess body weight places undue load on tendons,
  • keep active and healthy – tendons love to move and be used, so keeping active is a great way to keep them healthy,
  • avoid extreme stresses – jumping off high objects can place higher stress on the tendon although,
  • get help at the first sign of symptoms – the earlier that Posterior Tibial Tendon Dysfunction is treated with good support, the less severe it will become.
  • wear good supportive shoes which are appropriate to your activity – always wear the best shoes for the activity you’re doing. If you need advice on this you can get it from some of the better shoe stores like The Athlete’s Foot (no financial association with Dynamic Podiatry), or you can book an appointment with one of our super helpful podiatrists.

What is the Prognosis for Someone with Posterior Tibial Tendon Dysfunction?

The prognosis for PTTD depends on the severity of the condition. 

In some cases, symptoms may improve with conservative treatment as we mentioned above, ice, rest, orthotics and good shoes.

However, more severe cases may require surgery to repair the tendon. 

Surgeons can repair and tighten the tendon if necessary, and in severe cases they can perform an arthrodesis (joining of bones using screws) to improve the foot shape.

We believe that getting conservative treatment and preventing the need for surgery is the best course of action as recovery with foot surgery can be quite long and traumatic (between 1 and 12 months depending on the surgery required).

Unfortunately though there are times when surgery is definitely the best option.

The Dynamic Podiatry Team

Are you suffering from foot and/or ankle pain? 

Whether it’Posterior Tibial Tendon Dysfunction or any other lower limb condition, we’d LOVE to help you get back to normal activity without pain.

To make an appointment call 3351 8878 or click the link below to book online.

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