PTTD myths vs facts: what everyone gets wrong about posterior tibial tendon dysfunction

If you’ve been diagnosed with posterior tibial tendon dysfunction (PTTD) or suspect you might have it, you’ve probably heard a lot of conflicting information. Maybe a well-meaning friend told you that surgery is the only way to fix it. Or perhaps you read online that flat feet automatically mean problems down the road. Let’s clear this up.

There’s a lot of misinformation floating around about PTTD, and it can make an already confusing situation even harder to deal with. The truth is, understanding what’s actually true—and what’s not—can help you make better decisions about your treatment and avoid unnecessary worry.

Myth 1: “Only old people get PTTD”

This is one of the most common misconceptions about posterior tibial tendon dysfunction. While it’s true that PTTD is more common in people over 40, the idea that it only affects older adults is simply wrong.

The fact: PTTD can affect people of all ages, including young adults and even teenagers. Athletes, people with repetitive strain injuries, and those with certain anatomical risk factors can develop PTTD in their 20s and 30s. The posterior tibial tendon weakens and deteriorates for many reasons—not just aging.

What is true is that the condition becomes more common as we get older because tendons naturally lose some of their resilience over time. But age alone doesn’t determine whether you’ll develop PTTD. Lifestyle factors, activity level, foot structure, and genetics all play important roles.

If you’re younger and experiencing symptoms like inner ankle pain or difficulty with activities that involve pushing off your toes, don’t dismiss it just because you think you’re “too young.” Getting evaluated early can make a big difference in outcomes.

Myth 2: “Surgery is the only option”

This myth causes a lot of unnecessary anxiety. When people hear they have PTTD, they often assume they’ll eventually need surgery. The reality is quite different.

The fact: The vast majority of people with PTTD improve with conservative (non-surgical) treatment. Research consistently shows that early intervention with proper orthotics, physical therapy, and activity modification succeeds in most cases. Surgery is typically reserved for advanced cases where conservative measures have failed or when the condition has progressed significantly.

Conservative treatment for PTTD typically includes:

  • Custom orthotics or supportive shoes to correct overpronation
  • Physical therapy to strengthen the posterior tibial tendon and surrounding muscles
  • Activity modification to reduce stress on the tendon
  • Anti-inflammatory medications or ice to manage pain and swelling
  • Bracing or casting in severe cases

The key is catching it early. When PTTD is treated in its early stages, the success rate with non-surgical approaches is very high. Even in later stages, many patients avoid surgery through dedicated conservative care.

Myth 3: “Flat feet always cause problems”

Many people with flat feet panic when they learn about PTTD, assuming their flat feet are automatically a problem. But this isn’t necessarily true.

The fact: Flat feet (pes planus) are incredibly common and many people with flat feet never experience any pain or dysfunction. The issue isn’t having flat feet—it’s when flat feet become excessive or unstable enough to cause problems with the posterior tibial tendon.

In fact, having flat feet doesn’t mean you’re destined to develop PTTD. Many people have flexible flat feet that function perfectly well throughout their lives. The problems arise when the foot collapses excessively or when the posterior tibial tendon becomes overloaded relative to its capacity.

What matters is not whether your feet look flat, but whether you’re experiencing symptoms. Pain, swelling, difficulty with activities, or progressive flattening are the real warning signs—not the appearance of your arches alone.

Myth 4: “Rest is always best for PTTD”

When your tendon hurts, it seems logical to stop using it entirely. But complete rest isn’t always the answer—and can sometimes make things worse.

The fact: While acute rest is important during painful flare-ups, complete and prolonged immobilization can actually weaken the tendon and delay recovery. The posterior tibial tendon needs appropriate loading to heal and strengthen. This is why physical therapy is such an important part of treatment.

The key is finding the right balance. Too much activity aggravates the tendon, but too little allows it to decondition. A good physical therapist or podiatrist can guide you through exercises that safely load the tendon without causing further damage.

Gentle activities like swimming and cycling are often well-tolerated because they’re low-impact. Even walking, when done in supportive shoes and at reasonable distances, can be part of your recovery. The goal isn’t to eliminate all activity—it’s to find activities that maintain strength without aggravating your condition.

Myth 5: “PTTD will just go away on its own”

Perhaps the most dangerous myth is the belief that PTTD will simply resolve without treatment.

The fact: PTTD almost always progresses without appropriate treatment. The posterior tibial tendon doesn’t just “heal” on its own—it’s a degenerative condition that typically worsens over time if left untreated.

Early-stage PTTD (often called stage I) may present with mild symptoms that come and go. Without intervention, it can advance through the stages, eventually leading to significant foot deformity, chronic pain, and arthritis. Once the tendon has degenerated substantially, treatment becomes more complex and outcomes less predictable.

This is why early diagnosis and treatment matter so much. The sooner you address PTTD, the better your chances of stopping or slowing its progression. If you’re experiencing persistent inner ankle pain, especially with activity, don’t wait for it to magically disappear.

Why does this misinformation spread?

Understanding why these myths persist can help you be a more informed patient. Medical misinformation about PTTD spreads for several reasons:

Individual experiences get generalized. When someone has a bad experience with PTTD—perhaps they waited too long to seek treatment or needed surgery—they share their story. Others assume their situation will be the same, even though individual outcomes vary widely.

Outdated information lingers. Medical understanding of PTTD has evolved. Older sources may still reference approaches that have been superseded by better research.

Fear sells. Dramatic claims (“You’ll need surgery!”) get more attention than complicated truths (“Most people improve without surgery”). Scary headlines get clicks.

Details get oversimplified. The reality, that PTTD varies greatly from person to person, that treatment depends on many factors, doesn’t make for tidy soundbites.

Where to find reliable information

Now that you know what to ignore, where should you look for accurate information? Here are some guidelines:

  • Podiatrists and orthopedic specialists who regularly treat PTTD are the most reliable sources
  • Academic medical centers often have up-to-date information based on current research
  • Professional organizations like the American College of Foot and Ankle Surgeons publish patient education materials
  • Peer-reviewed research gives you the actual evidence (though it can be technical)

Be skeptical of anything that promises quick fixes, claims to work for everyone, or dismisses professional medical care entirely.

The bottom line

PTTD is a manageable condition, and the prognosis is generally good—especially with early intervention. Don’t let these myths prevent you from seeking treatment or cause you unnecessary stress. The key points to remember are:

  • PTTD can affect anyone, not just older adults
  • Most people improve without surgery
  • Flat feet alone aren’t a problem—symptoms are what matter
  • Appropriate activity is usually better than complete rest
  • Without treatment, PTTD typically progresses

If you think you might have PTTD, the best thing you can do is get evaluated by a qualified healthcare provider. Don’t let myths guide your decisions—let the facts do that.

Sources

  • Clinical experience and literature on posterior tibial tendon dysfunction treatment
  • Research on conservative vs. surgical outcomes for PTTD
  • Understanding of tendon healing and rehabilitation principles