Posterior Tibial Tendon Dysfunction

Is it possible to treat posterior tibial tendon dysfunction without surgery?

It may surprise you to learn that posterior tibial tendon dysfunction (PTTD) is not only a very common problem but that you or someone you know may actually suffer from it. The posterior tibialis muscle runs along the back of the calf and the posterior tibial tendon is what attaches it to the interior foot bones and supports the arch. If this tendon is injured, the result is often something that is a lot more familiar; flatfoot. 

Flatfoot, more specifically, adult-acquired flatfoot, is the term used to describe the collapse of the arch in the foot. It may not sound all that serious, but it can be quite painful, as well as potentially debilitating. Despite the fact that the posterior tibialis tendon is an extremely strong cord-like tissue, it can be damaged by being torn or inflamed. With sufficient damage, the tendon can become weakened to the point where it can no longer give the necessary support to hold the arch in place. This is posterior tibial tendon dysfunction, and it is the most common cause of adult flatfoot. 

Causes of Posterior Tibial Tendon Dysfunction

Flatfoot from PTTD can be the result of a wide variety of factors. It tends to occur more often in women than men and the likelihood increases with age. Some of the other more common risk factors include:

  • Injuries – like from a fall or accident
  • Overuse – this can be from walking, running, hiking and climbing stairs. High-impact sports, like basketball, are a fairly common cause of PTTD and the resulting collapse of the arch. 
  • Obesity
  • Diabetes
  • Rheumatoid arthritis
  • High blood pressure
  • Use of corticosteroids

Flatfoot Symptoms

A collapsed arch due to PTTD can be present in both feet but will happen independently, one at a time. Some of the signs and symptoms that this condition might be present include:

  • Pain – pain may be felt on the inside of the ankle and foot and it will typically be worse during physical activity.
  • Disappearing arch – there will be a visible flattening of the foot.
  • Inflammation – this will generally include a feeling of heat or warmth when touched, as well as the reddening of the skin along the inside of the ankle and foot.
  • Ankle rolling – as the arch collapses, the ankle will begin to roll inward.
  • Shifting of toes and foot – the toes and entire foot will start to turn 


Treatment recommendations for PTTD will begin with conservative, non-invasive methods. These include rest and ice, often combined with nonsteroidal anti-inflammatory medications, steroids, bracing, orthotics and physical therapy.   

In those cases where nonsurgical methods have not proven successful, your orthopedic specialist may advise posterior tibial tendon reconstruction surgery. This type of reconstructive surgery can be very complex and the specific technique used will depend on the location of the damage and just how extensive it is. Reconstruction surgery on the posterior tibial tendon will often require a fairly lengthy recovery period. 

If you have questions about posterior tibial tendon dysfunction or about any foot or ankle concerns, Dr. Christopher Hubbard is a board-certified Orthopedic Surgeon and is the former Chief of the Foot and Ankle Service at Mount Sinai Beth Israel in NYC. To schedule an appointment, or if you just have questions, please use our convenient online contact form by clicking here.