The posterior tibial tendon is one of the major supporters of the foot, helping to support the arch of the foot and inverting and plantar flexing the foot during gait. Posterior tibial tendon dysfunction (PTTD) is a condition that occurs when there are changes to the tendon such as with tendonosis (degeneration), inflammation, trauma or overuse. PTTD commonly affects only one foot but can be seen in both. PTTD is commonly referred to as adult acquired flat foot deformity as it causes a lowering, or flattening of the arch. It is a progressive condition which will worsen if not treated or treated early enough. People who are overweight or have diabetes are at increased risk for PTTD.



Symptoms include redness, tenderness, pain and swelling along the inside (medial) aspect of the foot and ankle, flattening of the arch, as well as a “rolling in” of the foot and ankle. As a result there will usually be increased pain with activities such as walking or running, weakness and a turning out of the toes as it progresses.


Pedorthic Management

  • Custom made orthotics – to provide the foot with arch support to relieve stress on the tendon
  • Orthopedic footwear – properly fitted, strong, and structured that is stable with good shock absorption and adequate heel height to reduce strain on the tendon. Footwear should be lace up or velcro type(not slip on) and have adequate width and depth to accommodate deformities caused by PTTD.
  • Footwear modifications – medial sole and heel flares, medial stabilizer and rocker soles


Other Treatments/ Modalities

  • Walking cast/boot – typically worn for 6-8 weeks – allows the tendon to rest and decrease swelling
  • AFO – Ankle Foot Orthosis – to support the foot and ankle, taking pressure and strain off the tendon
  • Anti-inflammatory or cortisone injections
  • Physiotherapy – to strengthen the tendon in mild to moderate cases
  • Surgery for more severe cases