Posterior Tibial Tendon Dysfunction

What is Posterior Tibial Tendon Dysfunction (PTTD)?

  • Posterior tibial tendon dysfunction (PTTD) is a condition that results in inflammation or tearing of the posterior tibial tendon. The posterior tibial tendon inserts into your foot along your instep, runs up behind the medial malleolus (the large bump on the inside of your ankle). This tendon plays a critical role in maintaining your arch and supporting your foot. If this tendon is not working properly, it will lead to an excessive pronation of the foot, resulting in “adult acquired flat feet”.


  • PTTD is caused by overuse of posterior tibial tendon over time. For instance, high-impact sports, such as basketball, tennis, or soccer, may cause tears of the tendon from repetitive use.


  • Pain and swelling on the inside of the ankle
  • Loss of the arch and development of a flat foot
  • Weakness and an inability to stand on the toes
  • Pain that worsens during activity


  • Most cases of PTTD are treatable without surgery. Treatment includes reducing pain and swelling and providing support to your foot to prevent further damage and recurrence. Custom orthotics can help support the foot and restore normal foot alignment, therefore reducing strain on the posterior tibial tendon. Depending on the severity of your PTTD, ankle brace or immobilization using a walking boot may be required.