Posterior Tibial Tendon Dysfunction

Posterior Tibial Tendon Dysfunction (PTTD)

Causes and Treatment

What is Posterior Tibial Tendon Dysfunction (PTTD)?

Your posterior tibial tendon is a fibrous cord which runs down the inside/back of your leg, beneath your ankle, and down into your arch. It plays a major role in helping us walk – without it, we’d struggle to stand on our tiptoes – and often do struggle when the tendon is injured.

When this tendon is injured, it is medically referred to as posterior tibial tendon dysfunction (PTTD).

What Causes PTTD?

PTTD is often an overuse condition. This occurs when heavy loads or excess strain is placed on the tendon, exceeding what it can safely handle. This overloading may be caused by:

Your foot type and gait characteristics, especially flat (pronated) feet
Regularly wearing unsupportive footwear
Increasing the intensity of physical activities like hiking, running, long-distance walking and even climbing stairs
Working on hard floors
Increased weight, which may place more pressure on the tendon

The Symptoms

Pain and tenderness on the inside of the shin, ankle or foot
Swelling
Muscle aches and fatigue in the affected area
Flattening of the affected arch (see below)

When the posterior tibial tendon is not functioning well, flattening of the foot can sometimes result, often referred to as adult acquired flat foot (AAFF).

The Pain Gets Worse Over Time

PTTD can be a progressive condition – the symptoms may worsen as the condition persists. This means that:

When your symptoms first begin, you may feel pain on the inside of the foot and ankle (along the course of the tendon). The area may also be red, warm, and swollen
As the condition worsens, your arch may begin to flatten. There may still be pain on the inside of the foot and ankle. At this point, the foot and toes begin to turn outward, and the ankle rolls inward
When left untreated, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The condition may progress to a point where the tendon may tear completely.