What are the Stages of PTTD?
PTTD has 3 stages: Stage 1 (mild, pain/swelling), Stage 2 (moderate, flatfoot develops), Stage 3 (severe, rigid flatfoot with arthritis). Early treatment prevents progression.
What are the Stages of PTTD?
PTTD progresses through three stages, and understanding which stage you’re in helps determine the right treatment.
Stage 1 (Mild): The tendon is inflamed but intact. Symptoms include pain and swelling along the inside of the ankle, especially during or after activity. The arch remains intact, and most patients respond well to conservative treatment including rest, ice, physical therapy, and orthotics. This stage can last months to years if untreated.
Stage 2 (Moderate): The tendon has weakened significantly and the arch begins to collapse. You’ll notice more pronounced flatfoot, increased pain, and difficulty with activities. Stage 2 is divided into Stage 2A (flexible flatfoot, tendon intact) and Stage 2B (tendon is elongated or torn). Conservative treatment may still work, but some patients need surgical intervention.
Stage 3 (Severe): The flatfoot becomes rigid (stiff), and arthritis often develops in the subtalar and ankle joints. Pain may shift to the outside of the ankle. Surgery is usually required at this stage to correct the deformity and relieve pain.
Early treatment in Stage 1 or 2 offers the best outcomes—don’t wait for symptoms to worsen.
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This content is for informational purposes and is not medical advice. Consult a healthcare provider for diagnosis and treatment.