Posterior tibial tendon dysfunction (PTTD) is a painful condition that affects the foot and ankle. It can affect your ability to walk or perform certain lower-body movements. PTTD can be treated through nonsurgical or surgical methods.
Posterior tibial tendon dysfunction (PTTD) is an issue that causes foot and ankle pain. It’s also known as posterior tibial tendonitis or posterior tibial tendon insufficiency. The posterior tibial tendon connects your calf muscle to bones on the inside of your foot. The main purpose of the tendon is to support the arch on the inside of your foot. When the tendon is injured or breaks down, it may no longer be able to support the arch. It can be a painful injury that negatively affects foot and ankle movements, including walking and running. PTTD is the most common cause of adult-acquired flatfoot.
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There are four posterior tibial tendon dysfunction stages:
PTTD most frequently affects women and people over the age of 40. The tendon often degenerates, or breaks down, as you get older. However, it can also affect those with conditions including:
The tendon can also experience damage from a fall or overuse. People who participate in high-impact sports or activities, including football, basketball, soccer, track and long-distance running, may tear the tendon from repeated use.
PTTD is a painful condition. If you have PTTD, making certain movements will be difficult for you. These movements may include standing, walking, running or standing on your toes.
Signs of PTTD may include:
Strong, repetitive forces can injure the posterior tibial tendon. As you get older, the tendon can break down. In people with obesity, additional body weight can cause the tendon to break down faster. Prior ankle, foot or joint injuries can also cause the tendon to break down quickly.
In younger people, PTTD is uncommon. It often occurs after an injury.
Your healthcare provider will look for swelling along the posterior tibial tendon in your ankle and foot. They’ll move your foot from side to side and check your ankle’s range of motion. Swelling, tenderness and pain or weakness when moving your foot or ankle are early signs of PTTD.
Your provider will examine your foot from behind to look for any changes in its structure or shape. Your heel may point outward, and your inner arch may rest flat on the ground. The front of your foot may also move away from your body to counterbalance the changes to the heel and inner arch.
From behind your foot, your provider will also look for a “too many toes” sign. In a normal foot, only the fifth toe (pinky toe) and part or all of the fourth toe (ring toe) are visible on the outside of the foot. In those with PTTD, more toes may be visible.
A single-limb heel rise test can also determine the health of your posterior tibial tendon. For this test, you’ll stand next to a wall or chair to support your balance. Then you’ll raise your healthy foot off the ground and attempt to lift onto the toes of your affected foot. With a healthy tendon, you should be able to complete eight to 10 heel raises comfortably. In the early stages of PTTD, it may not be possible to complete one single heel rise.
Imaging tests can help your healthcare provider confirm the diagnosis, including:
PTTD treatment depends on how severe your symptoms are. If tendon damage is identified in its earliest stages, many symptoms will go away with nonsurgical treatment, including:
If your pain doesn’t improve or completely go away after at least six months of nonsurgical treatment, you may be referred to a foot and ankle surgeon. Surgical treatments vary according to where your foot or ankle hurt. Treatments also vary according to the amount of damage to the tendon.
PTTD is a painful injury, and it can take several months to heal. You may have to change the ways you approach your daily activities. Slowly and carefully ease yourself back into any activities or exercises that you participated in before your injury.
You can reduce your risk of PTTD by:
With proper diagnosis and treatment, the outlook for people with PTTD is good. Take care to follow your healthcare provider’s instructions about appropriate footwear options and your physical therapy routine.
A note from Cleveland Clinic
PTTD is a common injury that affects the foot and ankle.
Injuries to your foot or ankle can be frustrating. If you’re not sure what’s caused the pain in your foot or ankle, or if you’re a woman or over the age of 40, stop any activity that increases the pain and contact your healthcare provider. Rest and over-the-counter or home remedies can treat PTTD in its earliest stages. In later stages, you may need to see a foot and ankle specialist. They’ll review more detailed treatment options with you, including any appropriate surgical procedures.
Last reviewed by a Cleveland Clinic medical professional on 11/04/2021.
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