Where Does PTTD Pain Occur?

The pain from posterior tibial tendon dysfunction has a fairly specific location pattern, which helps differentiate it from other foot conditions.

Primary location: inside of the ankle and foot. The most common pain spot is directly behind the medial malleolus — that’s the bony bump on the inner side of your ankle. This is where the posterior tibial tendon runs, and it’s where most people with PTTD feel their worst pain.

Along the arch. Pain often radiates forward along the course of the tendon, toward the middle of your arch. Some people feel it most in the arch itself, especially when pushing off while walking.

Occasionally up the calf. In some cases, the pain refers up the inner side of your calf. This is less common but can happen when the tendon is significantly inflamed.

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Key distinction: If your pain is on the outside of your ankle, it’s probably not PTTD — that’s more typical of peroneal tendon problems. Heel pain at the bottom of your foot is more likely plantar fasciitis. Generalized fatigue or aching across the entire foot could be early PTTD, but it’s harder to pin down without other signs.

PTTD pain typically worsens with activity (walking, standing, climbing stairs) and improves with rest and elevation. If your pain pattern matches this inside-ankle pattern, it’s worth getting checked out.