What Causes PTTD? Understanding Why It Develops

If you’ve been diagnosed with posterior tibial tendon dysfunction, you might be wondering what actually caused it. The honest answer is: it’s usually not just one thing. Most cases develop from a combination of factors that add up over time.

Let’s break down what typically leads to PTTD.

Understanding the tendon

The posterior tibial tendon runs along the inside of your ankle and foot. Its job is to support your arch and help you push off when walking. This tendon takes a lot of stress with every step you take.

Over time, that stress adds up. The tendon can start to fray, weaken, and eventually fail to do its job properly. That’s the basic mechanism behind most PTTD cases.

One of the biggest factors is simply time. The tendon naturally weakens as we get older. Most people with PTTD are between 40 and 60 years old, though it can affect younger people too.

This isn’t about being “out of shape.” It’s just that the tendon has been working hard for decades, and like everything else in the body, it shows signs of wear.

Acute injuries

Sometimes PTTD starts with a specific injury:

  • A fall where you twist your ankle
  • A sports injury
  • A sudden impact that strains the tendon

These acute injuries can trigger inflammation and damage that doesn’t heal properly, leading to chronic problems down the road.

Overuse and sports

High-impact activities put extra stress on the posterior tibial tendon. Runners, hikers, dancers, and athletes who do a lot of jumping are at higher risk. The repeated stress doesn’t give the tendon enough time to recover and repair.

This is why early symptoms often show up in people who’ve been active their whole lives. The tendon just eventually reaches a breaking point.

Biomechanical factors

How your foot moves matters a lot. If you overpronate (your foot rolls inward too much when you walk), that extra motion stresses the posterior tibial tendon with every step. Over years, that constant extra load takes a toll.

Flat feet are often associated with PTTD for this reason. But not everyone with flat feet develops the condition, and PTTD can happen even with normal arches.

Systemic conditions

Certain health conditions increase your risk:

  • Diabetes - affects tendon health and healing
  • Hypertension - can damage blood vessels that supply the tendon
  • Obesity - adds extra stress to the tendon with every step
  • Rheumatoid arthritis - causes inflammation that can affect tendons

If you have any of these conditions, it’s especially important to pay attention to early warning signs.

Genetic predisposition

Some people are simply born with tendons that are more prone to problems. If you have family members with foot or tendon issues, your risk may be higher.

This doesn’t mean you’re guaranteed to develop PTTD, but it does mean you should be more proactive about prevention and early detection.

Previous injuries

Old foot or ankle injuries that never fully healed can set you up for problems later. Even injuries that seemed minor at the time can leave the tendon weaker and more vulnerable.

The bottom line

Here’s what most people find reassuring: PTTD is rarely caused by something you did wrong. It’s usually a combination of factors:

  • The tendon aging and weakening
  • Your body mechanics
  • Lifestyle and activity level
  • Genetic factors you can’t control
  • Sometimes an injury that kicked things off

Understanding the causes helps you make informed decisions about treatment and prevention. But don’t blame yourself. Focus on what you can do now: get proper treatment, modify activities if needed, and work with your doctor on a plan.

Sources

  • AAOS (American Academy of Orthopaedic Surgeons) — PTTD Overview