How to Overcome Posterior Tibial Tendon Dysfunction and Relieve Pain
Posterior Tibial Tendon Dysfunction (PTTD) is one of the most common reasons adults develop flatfoot later in life. It often starts as pain or swelling along the inside of the ankle. Over time, if the tendon weakens too much, the arch of the foot can collapse, making it harder to walk, exercise, or even stand comfortably.
The posterior tibial tendon is like a key support strap for your foot. It helps hold up the arch and keeps the ankle steady when you push off while walking or running. When this tendon becomes inflamed, stretched, or torn, your foot can lose that support — leading to pain and changes in the shape of your foot.
Why It Happens
PTTD can develop for several reasons. Sometimes it follows an ankle injury, but more often it builds up slowly from everyday wear and tear.
Some common risk factors include:
Flat feet or rolling the feet inward (overpronation)
Repetitive stress from work, sports, or long walks on hard surfaces
Obesity, diabetes, or high blood pressure
Past ankle injuries or surgeries
Certain medications that can weaken tendons
The tendon usually starts by becoming irritated, but without treatment it can weaken and stretch — allowing the arch to fall and the ankle to shift outward.
What Symptoms to Look For
PTTD usually affects one foot at a time. At first, symptoms may feel mild but tend to get worse if ignored.
You may notice:
Pain or swelling along the inside of the ankle
Trouble standing on tiptoes or climbing stairs
Your arch looking flatter than before
Shoes wearing out unevenly
A feeling like you’re “walking on the inside of your ankle”
Pain moving to the outside of the ankle in later stages
A simple test doctors often use is the heel rise test. If you can’t lift your heel off the ground when standing on one foot, it may be a sign the tendon isn’t working properly.
Treatment Options
The good news is that early treatment works best, and many patients improve without surgery.
Non-Surgical Care
Rest and activity changes – Avoid activities that make the pain worse.
Supportive shoes or custom orthotics – Help support the arch and take stress off the tendon.
Boot or brace – Sometimes the ankle needs short-term support to heal.
Exercises and therapy – Strengthening the tendon and surrounding muscles, stretching tight calves, and correcting posture can all help.
Hands-on treatment – Soft tissue therapy, massage, or gentle joint mobilization may reduce pain and improve movement.
Anti-inflammatory care – Ice, medication, or other therapies may help in the early stages.
When Surgery Is Considered
If the condition has been present for a long time or if the foot has become stiff and deformed, surgery may be needed. This is usually reserved for patients who don’t improve with conservative care.
With early diagnosis and the right treatment plan, many people with PTTD can get back to walking, exercising, and daily activities without long-term issues. However, ignoring symptoms can lead to permanent flatfoot, arthritis, or chronic pain.
At Cole Pain Therapy Group, we focus on conservative, non-surgical treatments first — helping you heal naturally, restore your arch support, and get back on your feet with confidence.
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Richard L. Cole, DC, DACNB, DAIPM, FIACN, FICC
Jeffrey D. Luebbe, DC, CCRD, CCSP
W. Steven Vollmer, DC, DAAPM
Bradford J. Cole, DC, MS, CSCS
J. Colby Poston, DC
Daniel H. Smith, DC
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(901) 377-2340
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