Painful Flatfeet & Posterior Tibial Tendon Dysfunction (PTTD)
Understanding Painful Flatfeet & PTTD
The posterior tibial tendon is one of the most important structures supporting the arch of the foot. It runs along the inside of the ankle and attaches to several bones in the foot, helping maintain the arch and stabilize the foot during walking.
Posterior Tibial Tendon Dysfunction (PTTD), also known as Progressive Collapsing Foot Deformity (PCFD), occurs when this tendon becomes inflamed, stretched, or torn. As the tendon weakens, the arch gradually collapses, leading to painful flatfoot, difficulty walking, and progressive deformity if left untreated.
- Patients commonly experience:
Pain along the inside of the ankle and arch
Swelling over the posterior tibial tendon
Progressive flattening of the arch
Difficulty standing on tiptoes
Foot fatigue with walking or prolonged standing
Heel drifting outward as the deformity progresses
Early diagnosis and treatment can slow or prevent progression and help avoid surgery.
What Causes PTTD?
Posterior tibial tendon dysfunction typically develops from chronic overuse and gradual degeneration of the tendon, although several factors may contribute.
Common causes and risk factors include:
Flat feet or abnormal foot mechanics
Repetitive walking, running, or standing
Aging and tendon degeneration
Previous ankle injuries
Obesity
Diabetes
Inflammatory arthritis
Tight calf muscles
Poorly supportive footwear
As the tendon weakens, it can no longer adequately support the arch, allowing the foot to progressively flatten over time.
Conservative Treatment
Many patients experience significant improvement with non-surgical treatment, particularly when the condition is diagnosed in its early stages.
Treatment options include:
Rest and activity modification to reduce stress on the tendon
Ice therapy for 15–20 minutes several times daily to decrease pain and inflammation
NSAIDs such as ibuprofen or naproxen, when appropriate, to reduce inflammation
Stretching and strengthening exercises, especially for the calf muscles and posterior tibial tendon, to improve flexibility and stability
Supportive shoe gear with excellent arch support and a stable heel counter
Custom molded orthotics to support the arch, improve foot alignment, and reduce strain on the tendon
Physical therapy to improve strength, balance, flexibility, and walking mechanics
Cortisone Injections
Because corticosteroid injections can weaken tendons and increase the risk of tendon rupture, they are generally not injected directly into the posterior tibial tendon. In carefully selected cases, an ultrasound-guided injection into a nearby inflamed tendon sheath or joint may be considered to reduce pain and inflammation. Your podiatrist will determine whether this treatment is appropriate based on your specific condition.
Surgical Treatment
When conservative treatment no longer provides relief or the flatfoot deformity continues to progress, surgery may be recommended.
Surgical treatment is individualized based on the severity of the deformity and may include:
Repair or reconstruction of the posterior tibial tendon
Tendon transfer to restore arch support
Osteotomies (bone realignment procedures) to restore normal foot alignment
Ligament reconstruction
Joint fusion (arthrodesis) for advanced arthritis or severe deformity
The goal of surgery is to relieve pain, restore foot function, improve alignment, and prevent further progression of the deformity. Most patients are able to return to normal daily activities following recovery and rehabilitation.
Restore Your Arch. Restore Your Mobility.
Painful flatfeet and posterior tibial tendon dysfunction are progressive conditions, but early treatment can significantly improve symptoms and help prevent long-term deformity. Whether your treatment involves supportive footwear, custom orthotics, physical therapy, or surgical reconstruction, our goal is to relieve pain and help you return to comfortable, active living.
If you're experiencing pain along the inside of your ankle or notice that your arch is collapsing, schedule an evaluation with our office. We'll determine the cause of your symptoms and create a personalized treatment plan to keep you moving comfortably.