Posterior Tibial Tendon Dysfunction: The Arch Is Falling!

Using the words of William Shakespeare, some are born with flat feet, some achieve them, and some have flat feet thrust upon them! It’s true that babies commonly have feet with low or no arches. Most children develop an arch in their foot during the first few years of life when they start walking, but some never do and will always have flat feet. Others may “achieve” flat feet through wear and tear of the tendons over the years, or have it “thrust upon them” with a fall or other injury. When the main tendon that holds up the arch is damaged, a condition known as posterior tibial tendon dysfunction (PTTD) – or progressive flatfoot – can occur.

Who is at Risk for Progressive Flatfoot?

This is a foot condition which seems to strike women more often than men, especially after the age of 50. It also affects athletes who play soccer, tennis, basketball, or hockey because these sports put more stress on the posterior tibial tendon. Running on a banked track can have the same effect. Several medical conditions that increase your risk of damaging this tendon include diabetes, high blood pressure, and arthritis. If you are pregnant, overweight, or have had foot surgery or a previous fracture in the foot or ankle, your risk also increases.

Symptoms of PTTD

You may notice swelling on the inside of your foot, and pain during and after exercise that will lessen after you stop moving. Your arch may look flatter (try the wet feet on brown paper test: if the foot imprint is a solid oval, your arch has probably flattened).

If you don’t do anything about the condition, you may start to feel pain on the outside of the ankle as well, because as the arch flattens the heel bone moves out of position. The PTT runs from your calf muscle along the inside of your ankle, and it connects to the bones under the mid-foot. Many people with posterior tibial tendon dysfunction will feel pain right along the path of the tendon on the inside of their ankle.

What to Do for Posterior Tibial Tendon Dysfunction

First – and the sooner the better – have one of the specialists at Aadvanced Foot Care Associates take a look at your foot. By considering your medical history, examining the foot, and using diagnostic tests such as X-rays, CT scans, or MRIs, we can determine exactly what is happening. If caught early, the prognosis of finding relief with conservative treatments is good, although it may still take 3 months or more for the pain to fully disappear.

K Laser therapyRest and icing to reduce swelling and pain will be the first step. Orthotics for support and physical therapy to increase strength and flexibility in the feet can relieve PTTD in many patients. More severe cases may need braces, a leg cast, or walking boot for several weeks to allow the tendon to heal. The goal is to find relief without surgery, although that is a final option if conservative treatment does not solve the problem. The podiatrists of Aadvanced Foot Care Associates also utilize laser therapy, Prolotherapy, bio-injections, platelet rich plasma therapy (PRP) and the Ritchie Brace ankle foot orthosis to treat posterior tibial tendon dysfunction. Remember, cortisone should never be used in the presence of PTTD. There is a risk of rupturing the tendon, which is why Prolotherapy, bio-injections and PRP are the best treatments.

It is important to catch the problem early, so if you notice pain inside your foot or ankle, or can’t stand on one foot and raise up on your toes, you should schedule an appointment at our Rego Park, Plainview, or Flushing office as soon as possible. Call us at (718) 896-4433 or (516) 822-9595, or use our online contact page. With 100 years of combined foot care know-how, we can help you find relief from your pain!


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Rego Park
97-07 63 Road
Rego Park, NY 11374
(718) 896-4433

100 Maneto Hill Road, Suite 103
Plainview, NY 11803
(516) 822-9595

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