PTTD Symptoms: What to Watch For

If you’re feeling pain along the inside of your ankle or foot, you might be wondering what’s going on. Posterior tibial tendon dysfunction is more common than people realize, and catching it early can seriously affect your treatment options and recovery time.

Here’s what to look for.

Early warning signs

PTTD often starts subtly. In the beginning, you might notice:

  • Pain along the inside of your ankle or foot. This is the most common early symptom. It usually gets worse with activity like walking, running, or standing for long periods.
  • Swelling. You may see visible swelling along the path of the posterior tibial tendon, just below the ankle bone on the inside of your foot.
  • Fatigue in your arch. Your feet might feel tired or sore more quickly than usual, especially after being on them all day.

A lot of people dismiss these early signs as just general aches and pains. But if the pain is focused along that inner ankle area and keeps coming back, it’s worth getting checked out.

Symptoms by location

Arch pain

The posterior tibial tendon supports your arch. When it’s struggling, your arch may start to flatten. You might feel:

  • Aching in the middle of your foot
  • A feeling that your arch is “collapsing”
  • Pain that eases with rest but returns when you’re on your feet again

Ankle pain

The tendon attaches near the ankle, so discomfort shows up there first:

  • Pain behind the medial malleolus (that bony bump on the inside of your ankle)
  • Pain that radiates up the inside of your calf
  • A general sense of instability, especially on uneven ground

Heel pain

As the condition progresses, you might notice:

  • Pain on the inside of the heel
  • Pain that shifts to the outside of the ankle as your arch collapses and your foot alignment changes
  • A “too many toes” sign. When you look at your foot from behind, you see more toes than normal because your heel has rotated outward

Other common signs

Watch for these additional clues:

  • Difficulty standing on your toes. This push-off weakness is a hallmark sign. Try balancing on your toes; if it’s hard or painful, that’s a red flag.
  • Pain that worsens with activity. Unlike general fatigue, PTTD pain typically flares up during and after physical activity.
  • Changes in gait. You might start walking differently without realizing it, perhaps favoring one side.
  • Warmth along the tendon. Some people notice the area feels warmer to the touch.

How it differs from other conditions

PTTD symptoms can overlap with other foot and ankle problems. Here’s how to tell them apart:

  • Plantar fasciitis causes heel pain that’s often worst first thing in the morning. PTTD pain is more focused along the tendon path inside the ankle.
  • Achilles tendonitis pain is at the back of the heel, not the inside of the ankle.
  • Ankle sprains typically result from a specific injury and improve within weeks. PTTD pain comes on gradually and persists.

When to see a doctor

Don’t wait if you’re experiencing:

  • Pain that lasts more than a few weeks
  • Swelling that doesn’t go down
  • Difficulty with activities that were previously easy
  • Visible changes in your foot shape

Early intervention matters. The sooner you address PTTD, the more treatment options you have, and the more likely you can avoid surgery.

Bottom line: If you have persistent inner ankle pain, swelling along the tendon, or trouble with push-off activities, get it checked. Catching PTTD early gives you the best chance at a full recovery with less invasive treatment.

Sources

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