What is Posterior Tibial Tendon Dysfunction?

Posterior tibial tendon dysfunction (PTTD) is often referred to as adult acquired flat foot.  The posterior tibial tendon serves a vital function in the biomechanics of the foot and pathology of this tendon can lead to debilitating pain and possibly arthritis of foot and ankle.

Posterior tibial tendon dysfunction is a condition where the tendon has gone through changes, which makes it unable to support the arch of the foot, resulting in flattening of the foot.  Posterior tibial tendon dysfunction is the most common cause of flat feet in adults, hence “adult acquired flatfeet”. This condition can happen in one foot or both feet and in general it tends to be progressive in nature, especially if it is not treated early.

PRP Growth Factor Treatment Procedure

Signs and symptoms of Posterior Tibial Tendon Dysfunction:

  • Loss of arch height
  • Swelling to medial ankle (along the course of the tendon)
  • Inability to rise on the toes (single heel raise)
  • Pain to medial ankle with weight bearing
  • Lateral foot pain (sinus tarsi pain)
  • Inward rolling of the ankle
  • Toes starting to point towards the outside

Causes of Posterior Tibial Tendon Dysfunction:

  • Overuse
  • Not wearing supportive shoes
  • Foot sprain / trauma
  • Engaging in activities that involves the tendon: running, walking, hiking and climbing

Imaging: MRI may be a valuable tool in evaluating the integrity of the tendon

Conservative Treatment of Posterior Tibial Tendon Dysfunction:

PTTD Is progressive and early evaluation and treatment of this condition is strongly advised. If treated early enough, your symptoms may resolve without the need for possible surgical intervention.

In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities.

In many cases of PTTD, treatment can begin with non-surgical approaches that may include:

  • Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight-bearing for a while
  • Orthotic devices or bracing. Custom foot orthotics or Ankle Foot Orthosis (AFO) to support the arch and decrease tension on the tendon.
  • Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
  • Shoe modifications. Your foot and ankle surgeon may advise you to change your shoes to something more supportive.

When Is Surgery Needed?

Advanced progression or failed conservative treatment options of PTTD may require surgical intervention to address your pain and foot deformity.

We encourage you to consult with a foot and ankle specialist for a complete assessment of your condition.

Dr. Jones Hormozi at Valley Foot & Ankle Center (VFAC) utilizes state-of-the-art technology, minimally invasive procedures, and advanced techniques to prevent and treat all conditions of the foot and ankle. This allows most patients to walk immediately after most procedures, and they are able to rapidly return to high levels of functioning with excellent outcomes.


Dr. Jones Hormozi is a Board Certified Podiatrist in Los Angeles. Dr. Hormozi is known for treating sports injuries in patients of all ages. He has treated and operated on professional athletes, semi professional athletes, college athletes and high school athletes. Dr. Hormozi is also Clinical Assistant Professor of Podiatric Medicine and Surgery at Western University of Health Sciences.

Request an Appointment