PTTD Diagnosis: How Doctors Identify It

If you’re experiencing pain along the inside of your foot or ankle, you might be wondering whether it’s actually posterior tibial tendon dysfunction—and how a doctor would know for sure. Getting an accurate diagnosis is the first step toward proper treatment, and understanding what happens during your appointment can help ease some of that uncertainty.

What Happens at Your Appointment

When you see a doctor about potential PTTD, the visit typically starts with a conversation. Your doctor will ask about your symptoms—when the pain started, what makes it worse, and how it’s affecting your daily life. Be prepared to describe the location of the pain, how it feels (aching, sharp, burning), and whether you’ve noticed any swelling or changes in your foot shape.

This conversation helps the doctor understand your situation and guides what they look for during the physical exam.

Physical Examination Tests

The physical exam is the cornerstone of PTTD diagnosis. Your doctor will look for several telltale signs:

Looking at Your Foot

The doctor will have you stand and walk so they can observe your foot mechanics. They’re checking for:

  • Arch collapse — Whether your arch has flattened when you stand
  • Swelling — Any puffiness along the inside of your ankle or foot
  • “Too many toes” sign — When the doctor looks at your foot from behind, they can often see more toes than normal because the heel has rotated outward
  • Foot shape changes — The progression of PTTD often visibly changes how your foot looks

Testing Strength and Movement

Your doctor will likely have you perform a few simple tests:

  • Single limb heel rise: You’ll be asked to stand on one foot and rise up onto your toes. Difficulty with this—or pain when trying—can be a strong indicator of PTTD because the posterior tibial tendon is crucial for this motion.

  • Range of motion testing: The doctor gently moves your ankle and foot through different positions to check for stiffness or pain, particularly when turning your foot inward.

  • Resisted strength testing: You might push against the doctor’s hand in various directions to test the strength of different muscles and tendons.

These tests don’t require any special equipment—they’re practical ways to assess how well your posterior tibial tendon is functioning.

Imaging Tests Explained

Depending on what your doctor finds during the physical exam, they may recommend imaging to get a clearer picture of what’s happening inside your foot:

X-rays

X-rays are usually the first imaging test ordered. They show the bones and joints clearly, helping doctors see if there are any alignment problems, arthritis, or bone spurs developing. X-rays can’t show the tendon itself, but they reveal what the tendon problem has caused—changes in bone position and joint health.

Ultrasound

Ultrasound uses sound waves to create images of soft tissues, including tendons. It’s a quick, non-invasive way to look directly at the posterior tibial tendon and check for tears, inflammation, or degeneration. Your doctor might do this right in the office during your appointment.

MRI (Magnetic Resonance Imaging)

MRI provides detailed images of both soft tissues and bones. It’s particularly useful if the doctor suspects a significant tear in the tendon or wants to get a complete picture of all the structures involved. MRI is more expensive and takes longer than other tests, but it gives the most complete information.

CT Scan

A CT scan provides detailed 3D images of the bones. It’s less commonly used for initial PTTD diagnosis but may be ordered if surgery is being considered, as it gives surgeons a precise view of the bone structure.

Finding the Right Specialist

Who you see for diagnosis matters. Consider starting with:

  • Podiatrist: Specializes in foot and ankle conditions, including PTTD. Often the first stop for foot pain.
  • Orthopedist: Musculoskeletal specialist who can diagnose and treat PTTD, especially if surgery becomes necessary.
  • Sports medicine doctor: Good if your PTTD is related to athletic activity.

If you’re unsure, start with a podiatrist—they can refer you to an orthopedist if needed. The important thing is to see someone experienced with foot and ankle conditions, as PTTD can be mistaken for other issues.

Questions to Ask Your Doctor

Being prepared with questions helps you understand your diagnosis:

  • What stage of PTTD am I in?
  • What treatment options are available at this stage?
  • Do I need any imaging tests?
  • What should I do if my symptoms get worse?
  • How often should I follow up?

Getting a Proper Diagnosis

Early diagnosis matters with PTTD. The condition is progressive, meaning it tends to worsen over time if left untreated. The earlier it’s caught, the more treatment options you have—and the better the outcomes tend to be.

If you’ve been experiencing persistent pain along the inside of your foot or ankle, don’t wait to get it checked out. While the appointment might feel intimidating, the tests are straightforward, and knowing what you’re dealing with is the first step toward feeling better.

Sources

  • American Academy of Orthopaedic Surgeons (AAOS) - Posterior Tibial Tendon Dysfunction
  • Mayo Clinic - Flatfoot diagnosis information