Posterior Tibial Tendon Dysfunction (PTTD)

Posterior Tibial Tendon Dysfunction also known as (PTTD) occurs when the tibial tendon fails to support the structure of the foot's arch. This tendon connects the calf muscle to the bones on the inner side of the foot.

What You Need To Know About Posterior Tibial Tendon Dysfunction

What is Posterior Tibial Tendon Dysfunction?

The tibial tendon supports the arch of your foot, keeping your foot aligned properly. It enables freer toe movement and preserves your ankle from experiencing too much pressure as you walk. Posterior tibial tendon dysfunction occurs when the tendon is overstretched and becomes inflamed.

If you perceive any changes to the arch of your foot, you may be experiencing posterior tibial tendonitis. The overuse of your tibial tendon can result in progressing stages of adult flatfoot and could even cause trouble in your ankles and the inner parts of your foot.

In advanced stages of tibial tendonitis, your arch becomes unstable, and it may collapse. Keeping your posterior tibial tendon healthy is a vital step in continuing to walk with comfort and stability.

If you detect irregularity or experience any unusual pain in the inner tendon of your foot, contact the Foot & Ankle Center as soon as possible.

What Causes Posterior Tibial Tendon Dysfunction?

There is no single cause for posterior tibial tendon dysfunction. Most commonly, posterior tibial tendonitis results from excess use of the tendon supporting your arch. The stress from repeated impacts causes inflammation and sometimes tearing the tendon. High-impact sports, walking, hiking, climbing stairs, and running could cause your arch to flatten or agitate your tendon.

Additionally, a fall or a trip during everyday activities may also cause posterior tibial pain or dysfunction. Women, adults over the age of 40, and patients with symptoms of obesity, hypertension, or diabetes are more likely to develop tibial tendonitis.

Symptoms Of Posterior Tibial Tendon Dysfunction

There are many posterior tibial tendonitis symptoms. If untreated, symptoms of posterior tibial tendon dysfunction worsen over time and cause extreme discomfort and trouble when walking.

The following irregularities may be the results of tibial tendonitis and should be addressed by a doctor:

  • Swelling around the ankle

  • Pain in the arch or tendon when walking or standing

  • Flattening of the arch of the foot

  • Ankle displacement

  • Shifting of the heel bone

  • Arthritis in the foot

How Is Posterior Tibial Tendon Dysfunction Diagnosed?

During your physical examination, a Resurgens Physician will identify any swelling and will ask you to describe the pain you are feeling. They will determine the severity of your tendon damage by testing your range of motion through the bending of your toes inward, the movement of your ankle, and your ability to stand on the toes of the affected foot.

The use of diagnostic technology will help your physician understand the extent of your condition. The information from x-rays and MRIs will be used to help create your unique treatment plan.

Treatment For Posterior Tibial Tendon Dysfunction

Treatment options for posterior tibial tendonitis include rest, medications, and a support such as a shoe insert or a brace. In some cases, your doctor may recommend a cast or a walking boot, and in more severe cases, you may benefit from surgery.


In early stages of posterior tibial tendon dysfunction, simple treatments help amend pain and discomfort in as little as 3 months. Rest, Ice, elevation, and medication (such as naproxen or other painkillers and anti-inflammatory medications) may be some of the first steps your doctor takes in remedying your symptoms.

In many cases, orthotics or shoe inserts can be worn to help support your arch and relieve discomfort. Immobilization by use of a cast or brace may be recommended for a short period of time to allow the torn tendon to rest and heal properly.

After the healing process commences, physical therapy may help patients avoid stiffening or weakened muscles (especially in cases where casts are worn) so they can return to their usual activities. Other non-surgical options like injections may be used for posterior tibial tendonitis.


If the patient undergoing non-surgical treatment does not see improvement in six months, or if the physician deems a patient's posterior tibial tendonitis severe, surgery of some sort may be required. The complexity and invasiveness of the surgery depends on the level of deterioration in the tendon. A qualified foot and ankle surgeon will assist you in deciding which of the following procedures is best for you:

A few common surgical posterior tibial tendon dysfunction treatment options include:

  • Gastrocnemius Recession: Some patients require this surgery for help moving their ankles and keeping flatfoot from returning. The surgeon will lengthen the calf muscles during this procedure to restore some mobility to the ankle. Other surgeries may be necessary along with gastrocnemius recession.

  • Tendon Transfer: Occasionally, tibial tendonitis progresses to a stage where the damaged tendon must be replaced with other tendons in the foot. This procedure is called tendon transfer. After this procedure some movement will be restored to the patient, but returning to rigorous sports or activities may not be an option.

  • Osteotomy: Osteotomy is typically necessary if the patient's foot has deformed and needs to be reshaped. The procedure can involve bone cuts, bone grafts, and tendon transfers depending on the severity of flatfoot and dysfunction. Plates and screws may be required to keep the bones stable as they heal.

You don't deserve to be in pain. Schedule an appointment with the experts at Resurgens Foot & Ankle Center now!

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