How Is PTTD Diagnosed? A Complete Guide to the Diagnosis Process
Learn what to expect when getting diagnosed with posterior tibial tendon dysfunction, including physical exams, imaging tests, and staging.
How Is PTTD Diagnosed? A Complete Guide to the Diagnosis Process
If you’re experiencing pain along the inside of your ankle or foot, you might be wondering whether posterior tibial tendon dysfunction (PTTD) could be the culprit. Getting a proper diagnosis is the first step toward effective treatment—and the good news is that diagnosing PTTD is typically straightforward.
What to Expect at Your Appointment
When you see a doctor about suspected PTTD, they’ll start with a thorough evaluation that combines several approaches.
The Physical Examination
Your doctor will first review your medical history, asking about your symptoms—when they started, what makes them worse, and how they’ve affected your daily life. This conversation helps them understand the progression of your condition.
Next comes the physical exam. Your doctor will visually inspect your feet, looking for signs like:
- Swelling along the inner ankle
- Flattening of the arch
- Collapsing of the foot inward
- Abnormal foot posture when standing
They’ll also palpate along the posterior tibial tendon—that thick band running behind your medial malleolus (the bony bump on the inside of your ankle). Tenderness here is a key indicator of PTTD.
Your doctor will test your range of motion, particularly how well you can move your foot inward (inversion) and how flexible your arch is. Two common functional tests include:
- Single Limb Heel Rise: You’ll be asked to stand on one foot and rise up on your toes. Difficulty with this test often indicates posterior tibial tendon dysfunction.
- “Too Many Toes” Sign: When viewed from behind, the toes may appear to point outward more than normal because the foot has rolled inward.
Imaging Tests
While the physical exam often provides strong clues, imaging helps confirm the diagnosis and determine the severity:
- X-rays: These show bone alignment, the position of your arch, and whether arthritis has developed. They’re usually the first imaging test ordered.
- MRI (Magnetic Resonance Imaging): This provides detailed images of soft tissues, showing the condition of the tendon—whether it’s inflamed, degenerated, or torn.
- Ultrasound: This dynamic imaging lets doctors see the tendon in real-time as you move your foot, revealing tears or inflammation that might not show on static images.
Understanding PTTD Stages
Once diagnosed, your doctor will determine which stage of PTTD you have—this guides treatment recommendations:
| Stage | Characteristics |
|---|---|
| Stage 1 | Tendonitis with mild inflammation, no visible deformity |
| Stage 2 | Flexible deformity—the foot can still be manually corrected |
| Stage 3 | Rigid deformity—the foot cannot be manually aligned |
| Stage 4 | Arthritis has developed in the ankle joint |
Why Early Diagnosis Matters
The earlier PTTD is caught, the simpler the treatment. In early stages, rest, orthotics, and physical therapy often suffice. Later stages may require surgery. If you’re experiencing persistent inner ankle pain, especially with activity, don’t wait—see a podiatrist or orthopedic specialist.
What Comes Next
After diagnosis, your doctor will discuss treatment options based on your stage and lifestyle. For early-stage PTTD, non-surgical approaches are usually very effective. For advanced cases, surgery may be necessary to repair or reconstruct the tendon and realign the foot.
Key Takeaway: Diagnosing PTTD involves a combination of physical examination and imaging tests. The process is thorough but not overly complex—and catching it early leads to better outcomes.