PTTD and Rheumatoid Arthritis: Understanding the Connection

If you have rheumatoid arthritis (RA), you might have noticed changes in your feet that don’t quite fit the typical picture of posterior tibial tendon dysfunction. You’re not imagining it — the connection between these two conditions is real, and understanding it can make a big difference in how you manage your health.

What Rheumatoid Arthritis Does to Your Feet

Rheumatoid arthritis isn’t just about joint pain — it’s a systemic inflammatory condition that can affect nearly any structure in your body, including the tendons around your feet. The posterior tibial tendon, which runs along the inside of your ankle and arch, is particularly vulnerable.

When you have RA, your immune system mistakenly attacks the lining of your joints (the synovium). This creates inflammation that doesn’t just stay in the joint — it can spread to nearby tendons, ligaments, and bursae. For the posterior tibial tendon, this means the inflammatory process can weaken the tendon itself, making it more prone to dysfunction and collapse of the arch.

Research suggests that people with inflammatory arthritis conditions like RA are significantly more likely to develop flatfoot deformities, including PTTD, compared to the general population. One study found that up to 50% of people with RA will experience some form of foot deformity during their disease course.

PTTD that develops in the context of rheumatoid arthritis has some important differences from “classic” PTTD:

The inflammatory driver is different. In typical PTTD, the problem often starts with overuse or injury to the tendon. With RA, the primary driver is systemic inflammation attacking the tendon tissue itself. This means the treatment approach needs to address both the tendon problem AND the underlying inflammatory condition.

It can develop more rapidly. While classic PTTD typically progresses gradually over months or years, inflammation-driven tendon damage can accelerate the process.

Multiple structures are often involved. RA tends to affect multiple tendons and joints simultaneously. You might have PTTD alongside Achilles tendon issues, forefoot deformities, or ankle arthritis.

Treatment Considerations

Managing PTTD when you have rheumatoid arthritis requires a coordinated approach:

Control the inflammation first. This means working closely with your rheumatologist to get your RA well-managed. Modern biologic medications and DMARDs (disease-modifying antirheumatic drugs) can help control the systemic inflammation that’s damaging your tendons. When your RA is under better control, your foot symptoms often improve too.

Physical therapy with a twist. You’ll want to work with a physical therapist who understands inflammatory arthritis. The exercises are similar to standard PTTD rehab — strengthening the posterior tibial tendon, improving ankle stability — but they need to be carefully dosed given the inflammatory context.

Orthotics are crucial. Custom orthotics can help support your arch and reduce stress on the posterior tibial tendon. Because RA affects joint laxity, the orthotic needs to address both arch support and overall foot stability.

Surgery requires extra caution. If surgery becomes necessary, the presence of RA adds complexity. Healing may be slower, and surgeons need to consider the overall health of your joints and tissues. Many surgeons recommend waiting until RA is in remission before undergoing any elective foot surgery.

Working With Your Healthcare Team

The key to managing PTTD with RA is coordination:

  • Your rheumatologist should be in the loop about any foot or ankle symptoms. They may adjust your RA medications if inflammation is contributing to tendon problems.

  • A podiatrist can provide custom orthotics and monitor foot changes over time.

  • A physical therapist with experience in inflammatory arthritis can guide appropriate exercise.

  • An orthopaedic foot specialist may be needed if surgical intervention becomes necessary.

Don’t assume foot pain is “just part of having RA.” PTTD is treatable, and getting proper care can significantly improve your quality of life.

What You Can Do

If you have RA and notice any of these signs, talk to your doctor:

  • New pain on the inside of your ankle or arch
  • Progressive flattening of your foot’s arch
  • Difficulty walking barefoot or on uneven surfaces
  • Swelling along the posterior tibial tendon

Early intervention makes a difference. The sooner you address PTTD symptoms, the better your outcomes tend to be — regardless of your RA status.

Sources

  • American College of Rheumatology guidelines on foot and ankle care in RA
  • Journal of Rheumatology studies on foot deformities in inflammatory arthritis
  • Arthritis Foundation resources on RA and foot health