East Coast Podiatry
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Last Updated: 13 Sep 2019

Posterior Tibial Tendon Dysfunction (PTTD)

Posterior Tibial Tendon Dysfunction (PTTD) is a common problem in the foot and ankle. It occurs mostly in adults and is a leading cause of Adult Acquired Flatfoot Deformity (AAFD).

The Posterior Tibial tendon, also known as the tendon of the Tibialis Posterior muscle, arises from the calf, runs through the inside of the ankle and attaches to the foot around the arch. It is a very important tendon in the foot as it is mainly responsible for pulling up the arch and supporting the foot and ankle during walking or running.

PTTD occurs due to the weakening of the Tibialis Posterior tendon of the lower leg as well as the failure of the ligaments around the foot and ankle. This leads to the collapse of the medial arch and flattening of the foot, resulting in a flat foot deformity.

PTTD Posterior Tibial Tendon Dysfunction Skeleton Feet


  • Pain present on the inside of the foot and ankle, swelling may or may not be present
  • Increased pain and foot weakness with physical activities, such as walking and running
  • A gradual flattening of the affected foot
  • Pain in the ankle due to the progressive foot deformity causing joint impingement

Causes and Risk Factors

An acute injury may tear the Tibialis Posterior tendon and cause inflammation and pain. However, the majority of PTTD arise from overuse and repetitive strain to the Tibialis Posterior tendon.

Some risk factors of PTTD include:

  • Pre-existing flat foot
  • Hypermobility
  • Being 40 years or older
  • Obesity
  • Diabetes
  • Hypertension
  • Engage in high impact sports


One treatment that you can try at home is the R.I.C.E treatment. The first and most important step is to Rest the injury by cutting back on daily activities. Icing the injury using an ice pack for 15 minutes several times a day calms down the damaged tissue and slows down blood flow to an injury, reducing swelling, inflammation and controlling the pain. Compression can be performed using an elastic wrap or bandage. Lastly, Elevate the affected limb to reduce the swelling.

If the pain and swelling persists after 7-10 days, it may mean that you have a more severe injury. Our podiatrists are able to diagnose the problem and offer conservative treatment options. This may include focal shockwave therapy to stimulate healing and reduce the pain.

Customised orthotics are required to control the flat foot deformity and to reduce the pressure and stress placed upon the Tibialis Posterior tendon.

If there is a visible change to the shape of your foot and ankle, an ankle-foot orthosis (AFO) may be required to prevent the deformity from worsening. A fully customised light-weight hinged AFO which will prevent the PTTD from worsening and keep the foot from further damage.

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