PTTD FAQ: Your Questions Answered

If you’re dealing with posterior tibial tendon dysfunction, you probably have questions. Here are answers to the most common ones I hear from people researching this condition.

What exactly is PTTD?

Posterior tibial tendon dysfunction (PTTD) is a condition where the posterior tibial tendon — the tendon that supports your arch and helps you walk — becomes damaged, inflamed, or weakens over time. This leads to progressive flattening of the foot arch, often called acquired flatfoot.

Is PTTD curable?

PTTD is treatable, especially when caught early. Many people recover fully with conservative treatment like physical therapy, orthotics, and activity modifications. Advanced cases may require surgery, but even then, most people see significant improvement. The key is early intervention — don’t wait until the damage is severe.

Will I need surgery?

Not necessarily. Most people with PTTD (some studies suggest 75-85%) improve without surgery. Surgery is typically reserved for cases where:

  • Conservative treatment hasn’t worked after several months
  • The tendon is severely damaged or ruptured
  • There’s significant arch collapse or deformity
  • Conservative treatment hasn’t worked after several months

Can I still exercise with PTTD?

Yes, but you need to be smart about it. Low-impact activities like swimming, cycling, and elliptical trainers are generally safe. You’ll want to avoid high-impact activities and exercises that put excessive strain on the posterior tibial tendon. A physical therapist can help you modify your workouts.

How long does treatment take?

This varies widely depending on the stage of your PTTD and how well you respond to treatment:

  • Early stage (Stage 1): 2-4 months of conservative treatment
  • Middle stage (Stage 2): 4-6 months, sometimes longer
  • Advanced stage (Stage 3): Surgery + 6-12 months recovery

Patience is key — trying to rush the process often leads to setbacks.

Is PTTD hereditary?

There’s no single “PTTD gene,” but some factors that contribute to PTTD can run in families:

  • Foot structure (naturally low arches or flexible flatfoot)
  • Connective tissue disorders
  • Family history of tendon problems

However, having these risk factors doesn’t mean you’ll definitely develop PTTD — they’re just things to be aware of.

Can PTTD come back after surgery?

It can, though it’s not common. The success rate for PTTD surgery is generally high (around 80-90% satisfaction). To minimize recurrence:

  • Follow your post-op rehabilitation plan exactly
  • Continue any recommended exercises long-term
  • Wear orthotics as prescribed
  • Avoid returning to high-impact activities too quickly

What’s the difference between PTTD and regular flatfoot?

Not all flatfoot is PTTD. “Flexible flatfoot” is often congenital (you’re born with it) and doesn’t typically cause pain or problems. PTTD is an acquired flatfoot that develops over time due to tendon dysfunction. The key difference is that PTTD is progressive — it gets worse if left untreated.

Can PTTD affect both feet?

Yes, though it’s less common. Bilateral PTTD (affecting both feet) is more likely in people with systemic conditions like rheumatoid arthritis, diabetes, or certain connective tissue disorders. If you develop symptoms in one foot, pay attention to the other — early signs can be subtle.

Does weight affect PTTD?

Yes, carrying extra weight increases stress on your feet and tendons. While that’s not a reason to feel ashamed about your weight, it is a good reason to work with your doctor on a sensible weight management plan if needed. Even modest weight loss can reduce the strain on your posterior tibial tendon.

When should I see a doctor?

Don’t wait if you notice:

  • Pain along the inside of your ankle or arch
  • Swelling or warmth in the area
  • Difficulty walking or standing for long periods
  • A foot that’s becoming progressively flatter
  • Pain that worsens with activity

Early treatment is much easier than treating advanced PTTD.