Posterior Tibial Tendon Dysfunction: What It Is and Why Your Foot Hurts
If you’ve been dealing with pain on the inside of your ankle, or notice your arch slowly disappearing, you might have posterior tibial tendon dysfunction (PTTD). It’s a frustrating condition, and if you’re reading this, you probably already know something’s wrong.
Let’s break down what PTTD actually is, what’s happening inside your foot, and why it matters for your mobility.
What is posterior tibial tendon dysfunction?
Posterior tibial tendon dysfunction is a condition where the main tendon that supports your arch becomes damaged, weakened, or inflamed. This tendon (the posterior tibial tendon, or PTT) acts like a cable that holds up the arch of your foot.
When this tendon isn’t doing its job properly, your arch gradually collapses. That’s why PTTD is the leading cause of adult-acquired flatfoot. It’s not something you’re born with. It develops over time.
Doctors also call this condition progressive collapsing foot deformity (PCFD), which describes what happens as the condition advances: the foot progressively collapses inward.
The anatomy: How your posterior tibial tendon works
Your posterior tibial tendon is one of the most important structures in your foot. Here’s what it does:
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Supports your arch — This is its primary job. The tendon attaches to the navicular bone and other bones on the inside of your foot, holding up that natural curve.
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Enables proper push-off — When you walk or run, this tendon helps you push off from your toes. Without it, your gait becomes inefficient.
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Stabilizes your hindfoot — It works alongside other tendons and ligaments to keep your ankle and foot aligned.
Think of it like a hammock string. When it’s strong and tight, your foot maintains its shape. When it becomes loose or frayed, everything sags.
What happens when this tendon fails
PTTD doesn’t happen overnight. It’s usually a gradual process:
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Inflammation or micro-tears — The tendon becomes irritated, often from overuse or repetitive stress.
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Degeneration — Over time, the tendon tissue weakens and loses its strength.
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Arch collapse — Without adequate support, your arch slowly flattens.
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Compensatory changes — Other structures in your foot and ankle try to pick up the slack, often leading to pain in new places.
The progression varies significantly from person to person. Some people experience a slow, barely noticeable change over years. Others notice a more rapid decline, especially after an injury or period of increased activity.
Who gets PTTD?
PTTD is most common in certain groups:
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Women over 40 — The condition affects women significantly more than men, typically appearing in middle age.
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People who are overweight — Extra body weight places additional stress on the tendon.
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Those with diabetes or hypertension — These conditions can affect connective tissue health.
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Active individuals — Runners, tennis players, and others who place repetitive stress on their feet.
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People on their feet all day — Teachers, nurses, retail workers, and others who stand for extended periods.
If any of these apply to you, it’s worth paying attention to early signs.
Early warning signs you shouldn’t ignore
PTTD often starts subtly. Watch for:
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Pain along the inside of your ankle — Especially during or after activity, or after long periods on your feet.
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Swelling — Along the inside of your ankle, particularly after exercise.
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Weakness — Difficulty standing on your tiptoes on the affected side.
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Foot fatigue — Your feet getting tired faster than usual.
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Visible changes — Your arch appearing lower, or your heel rolling inward.
The earlier you catch these signs, the better your chances of managing the condition without surgery.
When to seek help
If you’re experiencing any of the symptoms above, it’s worth talking to a healthcare provider. PTTD is progressive. It tends to get worse over time if left untreated.
The good news is that early-stage PTTD responds very well to conservative treatment. Many people successfully manage their symptoms with physical therapy, supportive footwear, and orthotics. They never need surgery.
Understanding the condition is the first step
Now that you understand what PTTD is and how it develops, you’re better equipped to recognize the signs and take action. Knowledge is power when it comes to foot health.
Want to learn more? Explore our detailed guides on PTTD stages, treatment options, and exercises that can help strengthen your foot.
Sources
- American Academy of Orthopaedic Surgeons (AAOS) — PTTD overview
- Mayo Clinic — Adult flatfoot information
- Research literature on posterior tibial tendon pathology
This article is for educational purposes only. It’s not a substitute for professional medical advice. If you’re experiencing foot or ankle pain, please consult a qualified healthcare provider.