Early Signs of PTTD: What to Watch For
Posterior tibial tendon dysfunction usually develops gradually, which means there's often a window where you can catch it early and intervene before i
Early Signs of PTTD: What to Watch For
Posterior tibial tendon dysfunction usually develops gradually, which means there’s often a window where you can catch it early and intervene before it progresses. Here’s what to look for:
Pain along the inside of your ankle and foot. This is the hallmark early sign. The posterior tibial tendon runs along the inside of your ankle, so pain in this area — especially when walking, standing, or going up stairs — is a red flag. It might feel like aching, throbbing, or sharpness. Many people mistake it for shin splints or general foot fatigue at first.
Swelling and warmth along the tendon. If you look at the inside of your ankle and notice visible swelling or feel warmth compared to the outside of your ankle, that’s a sign of inflammation in the tendon.
Flattening of your arch when standing. One of the most telling signs is a medial arch that collapses or flattens when you’re on your feet — but reappears when you sit down or lift your heel off the ground. Stand on both feet and have someone look at your feet from behind. If your arches look different than they used to, pay attention.
Difficulty rising onto your tiptoes. Try standing next to a counter for balance and lifting one foot off the ground. If you can’t do a single-limb heel rise — or it hurts to try — that’s a strong indicator of posterior tibial tendon weakness.
Pain that’s worse in the morning. Many people with early PTTD notice their foot feels stiff and painful when they first get out of bed, then loosens up after walking for a few minutes. This differs from arthritis pain, which often gets worse throughout the day.
The “too many toes” sign. When viewed from behind while standing, more of your toes become visible on the affected side because the foot has rolled outward. This is a classic clinical sign that something is wrong with the tendon supporting the arch.
What to do next: If you’re noticing one or more of these signs, schedule an appointment with a podiatrist or foot specialist. Early intervention — with orthotics, physical therapy, and activity modification — can often stop PTTD from progressing to the point where surgery becomes necessary.