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Posterior Tibial Tendon Dysfunction (PTTD)

What Is Posterior Tibial Tendon Dysfunction (PTTD)?

The posterior tibial tendon is one of the strongest tendons in the foot and ankle. Its main job is to help support the arch of the foot and provide power during the push off. It starts on the inside of the ankle and travels down to the middle of the foot where it ends on the navicular bone. It can become dysfunctional in people who have a flat foot or an extra bone at the site of attachment. As this tendon becomes increasingly dysfunctional, the foot can progressively flatten. 


Overuse is a common cause of PTTD. However, foot structure can play a role in progressive developments, as well as trauma to the tendon (such as a rupture). 

• Flatfeet

• Trauma, such as an ankle sprain or falling

• Systemic disorders like rheumatoid arthritis


The symptoms can be progressive and nature and change with time.

• Pain and swelling

• Tingling or burning pain around the inside of the ankle

• Loss of arch height or flattening of the foot

• Loss of muscle strength around the inside of the ankle

• Joint pain in the middle of the foot

Non-Surgical Treatment

An important concept to understand is that PTTD is a progressive deformity: it gets worse with time. Early interventions can help slow the development of the deformity and reduce pain. More advance cases can lead to extremely painful and arthritic feet.

• Bracing can be helpful

• Physical therapy for strength training

• A Custom molded prescription orthotic made by a foot and ankle physician

• Injection therapies to reduce inflammation (we often use platelet-rich plasma)

• Immobilization may provide relief

• Medications such as anti-inflammatories

When Is Surgery Needed?

In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Surgery for PTTD is typically a mix of soft tissue type repairs of tendons combined with bone work like fusions or cutting and realigning of bones.