PTTD in Athletes: Sports-Specific Guidance for Returning to Play

Being an athlete with posterior tibial tendon dysfunction is frustrating—you need to move to perform, but movement is exactly what’s causing the problem. Whether you’re a weekend warrior or compete at a higher level, here’s how to think about PTTD in the context of your sport.

Why Athletes Get PTTD

The posterior tibial tendon takes a beating in sports. It works overtime to stabilize your arch every time you push off, change direction, or land from a jump. Athletes put massive repetitive stress through this tendon, and when the loading exceeds what the tendon can handle, PTTD develops.

These sports carry the highest risk:

  • High-impact landings — Basketball, volleyball, tennis
  • Repeated pushing off — Soccer, track events, dance
  • Explosive directional changes — Football, basketball, tennis
  • Endurance demands — Long-distance running, triathlon

If you’re playing any of these and notice inner ankle pain that gets worse with activity, don’t ignore it. Early-stage PTTD is much easier to treat.

Prevention Strategies That Actually Work

You can’t always prevent PTTD, but you can lower your risk:

Don’t increase training too fast. Sudden jumps in mileage or intensity are a major trigger. The 10% rule is real—don’t add more than 10% to your weekly training load.

Strengthen your hips and glutes. Weak hips make your feet work harder. Strong glutes absorb impact before it reaches your ankles.

Replace your shoes. Running shoes lose cushioning after 300-500 miles. If you’re playing sports, replace court shoes regularly too.

Get orthotics if you have flat feet. If you’ve always had low arches, custom or quality over-the-counter arch supports help distribute force evenly.

Training Modifications When You Have PTTD

Here’s the hard truth: you probably need to modify what you do. General approach:

Lower the impact. Swim or cycle instead of run. Trade basketball for swimming or elliptical until you recover.

Cut your sessions shorter. Two 20-minute sessions can be better than one 45-minute one. Pain is a guide—use it.

Play on softer surfaces. Grass and tracks are easier on your feet than concrete or old hard courts.

Try compression or bracing. Some athletes like compression sleeves. Others need the more serious support of an ankle brace. Find what works for you.

Returning to Your Sport

Recovery is a graduated process:

Start easy. 25-50% of normal volume. Focus on form, not intensity. No jumping, no explosive movements at first.

Add sport-specific work. Short drills, basic footwork at reduced intensity. See how your tendon responds the next day.

Ease into full practice. Gradual return to practices. Keep monitoring pain during and after. Be ready to scale back if needed.

Back to competition. Full return to play, but keep up the preventative habits. This isn’t a “one and done” thing.

Some Gear Can Help

  • Custom orthotics — Expensive but worth it if you have specific biomechanical issues
  • Over-the-counter arch supports — Good starting point for mild cases
  • Ankle braces — The ASO style works well for many athletes—supportive but not too restrictive

The Bottom Line

PTTD doesn’t have to end your athletic career. Most athletes return to their sports with smart modifications and patient rehab. The key is being willing to adjust—not push through pain, but also not give up entirely.

Find a sports medicine podiatrist or orthopedic surgeon who works with athletes. They get that you want to compete and can help you balance return-to-play goals with keeping your tendon healthy long-term.

This article is for informational purposes only and is not medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment specific to your situation.