Posterior Tibial Tendon Dysfunction (PTTD): What You Need to Know About Adult Flatfoot

As a board-certified podiatrist, I regularly treat patients who come in with foot pain, arch collapse, or difficulty walking—often without knowing the underlying cause. One of the most common culprits I diagnose in middle-aged and older adults is Posterior Tibial Tendon Dysfunction, or PTTD.

This condition is a progressive and often debilitating disorder that, if left untreated, can lead to permanent foot deformity. Fortunately, with early intervention, we can manage it effectively and help you stay mobile and pain-free.

What Is Posterior Tibial Tendon Dysfunction?

PTTD occurs when the posterior tibial tendon, which runs along the inside of the ankle and foot, becomes inflamed, stretched, or torn. This tendon plays a critical role in supporting the arch and stabilizing the foot while walking.

When it becomes dysfunctional, the foot can gradually flatten, leading to what’s commonly known as adult-acquired flatfoot.

What Causes PTTD?

• Overuse or repetitive strain (common in runners, athletes, or individuals on their feet all day)

• Obesity

• Trauma or injury

• Age-related tendon degeneration

• Inflammatory conditions such as rheumatoid arthritis

Symptoms of PTTD

PTTD typically progresses through four stages. Common signs include:

• Pain and swelling along the inside of the ankle or arch

• Flattening of the foot (loss of arch)

• Rolling in of the ankle (pronation)

• Difficulty standing on tiptoe

• Pain that worsens with activity

• In later stages, pain may develop on the outside of the ankle due to compensation

If caught early, PTTD can be managed without surgery. If ignored, it may lead to rigid flatfoot, arthritis, and permanent deformity.

How Is PTTD Diagnosed?

In our Laguna Hills clinic, we perform a physical exam, assess your gait, and often order X-rays, ultrasound, or MRI to determine tendon integrity and stage of progression.

Treatment Options for PTTD

1. Conservative Treatment (Early Stages)

• Rest and activity modification

• Custom orthotics or ankle braces (Arizona Brace) to support the arch and tendon

• Anti-inflammatory medications

• Physical therapy to strengthen supporting muscles

• Immobilization using a walking boot during flare-ups

2. Surgical Treatment (Advanced Stages)

If conservative measures fail and deformity progresses, surgery may be needed to repair or reconstruct the tendon, realign the foot, or fuse joints if arthritis is present.

At Laguna Woods Podiatry Group, we always prioritize non-invasive solutions first and tailor the treatment plan based on your symptoms, lifestyle, and goals.

Who Is Most at Risk for PTTD?

• Adults over 40

• Women more than men

• Those with obesity or diabetes

• Individuals with a history of foot injuries or inflammatory diseases

Why Early Diagnosis Matters

The earlier we catch PTTD, the better the outcome. Many patients can avoid surgery altogether with proper bracing, orthotics, and rehabilitation. Ignoring the symptoms can lead to irreversible changes in the foot structure.

Trusted PTTD Treatment in Laguna Hills and Surrounding Cities

At Laguna Woods Podiatry Group, we specialize in diagnosing and treating Posterior Tibial Tendon Dysfunction and other complex foot and ankle conditions. We proudly serve Laguna Hills, as well as Mission Viejo, Aliso Viejo, Lake Forest, Laguna Niguel, Dana Point, Irvine, San Juan Capistrano, Ladera Ranch, and Rancho Santa Margarita.

If you’re experiencing foot pain, arch changes, or balance issues, don’t wait—schedule an evaluation today and take the first step toward healthier feet.

—

Dr. Neda Arjomandi
Board-Certified Podiatrist
Laguna Woods Podiatry Group
📍 Laguna Hills, CA
🌐 www.lagunawoodspodiatry.com
📞 949-581-2520

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.