Sign In

Posterior tibial tendon dysfunction (PTTD)

Also referred to as:
Adult Acquired Flat Foot • Tibialis Posterior Tendon Dysfunction

Watch the video

What is PTTD?

This is a problem that occurs when the Posterior or Posterior Tibial tendon becomes either inflamed, torn, damaged, thickened and/or dysfunctional. The tendon is very important because it is the main tendon that supports the “medial arch” of the foot. So when it becomes dysfunctional and problematic, not only does the tendon become painful, but it no longer “supports the arch” properly, which can lead to foot deformity.

The problem is usually graded in stages with the early stages being moderate dysfunction and foot deformity, and the latter stages being severe dysfunction and a fixed, “flat footed” deformity, usually with associated ankle and forefoot/toe problems too (such as bunions).

Lots of people naturally have “flat feet” which can cause pain, but this is dependent on many factors. PTTD is a more specific, usually painful and progressive condition, often associated with the ageing process but also bodyweight and certain activities may put you at more risk. It often presents in only one foot (what we call unilateral) however the other foot can become affected down the line too.

Healthy tendons can become problematic when they are overused, but unhealthy tendons can develop problems during otherwise normal activities such as walking or standing.

How can I help myself?

Wearing supportive footwear such as walking boots/ankle boots may help. Foot orthoses/insoles, braces and a variety of strengthening and stretching exercises may also be useful. If it is painful and swollen, POLICE and anti inflammatory medication may be useful.

When to see a Podiatrist?

It is very important to have this problem assessed because it can become serious resulting in permanent foot deformity. Early intervention may successfully slow the progress.

In severe cases, the foot may need to be immobilised for a period of time to try to reduce pain and swelling in the tendon. A Podiatrist will be able to assess your foot shape, mechanics and strength/function of the tendons and develop a management plan based on the severity of your problems.

We often see patients with bad corns, callus or bunions as a result of PTTD.

In some cases, fixed hinged braces can be needed to really support the foot and ankle, and sometimes surgery is needed too. There are a variety of surgical procedures that may be selected, based on severity of the problem.

If you book an appointment with a Podiatrist, it is wise to take the footwear you usually wear so that you can show them.

If you have diabetes or suffer with neuropathy and notice any changes in foot shape, often accompanied with heat or swelling, this could be something called Charcot Foot (See bottom of Diabetes page) which needs urgent assessment.