Posterior Tibial Tendon Dysfunction (PTTD)

What is Posterior Tibial Tendon Dysfunction (PTTD)

Posterior tibial tendon dysfunction occurs when the posterior tibial tendon degenerates or tears. This tendon is one of the main support mechanisms of the arch and as a result, with its dysfunction the arch of the foot is no longer supported which can result in a flat foot deformity.

People with this problem generally are unable to stand on one leg and lift the heel off the ground and if the condition has been present for a while they commonly present with a flat foot. Typically pain is also present along the course of the tendon,  just behind or below the ankle joint (see yellow area)

Ultrasound examination at The Foot and Ankle Centre can assist in diagnosing this problem. Below shows the position of the probe and the findings in posterior tibial tendon degeneration.

Probe position Note the fluid surrounding the tendon Fibres of the tendon are discontinuous


Causes of Posterior Tibial Tendon Dysfunction (PTTD)

  • Trauma – acute trauma to the tendon can result in its degeneration this is commonly seen in inversion ankle sprains
  • Certain Connective tissue disorders
  • Biomechanical abnormalities- The main cause of Posterior TIbial Tendon Dysfunction is having an overly flat foot.  This is because the position of the foot changes the demand from certain muscle groups.
    Neutral Foot In a neutral foot  the muscles on the inside of the foot (invertors) work just as hard as the muscles on the outside of the foot (evertors).
    Flat Foot In a flat foot the muscles on the inside of the foot (invertors) work a lot harder to try and correct the position of the foot  – overtime this can result the degeneration of the tibialis posterior tendon.

Stages of Posterior Tibial Tendon Dysfunction

  • Stage 1 – Posterior tibial tendon intact and acutely inflammed, no deformity, mild -moderate swelling
  • Stage 2 – Posterior tibial tendon dysfunctional, acquired flat foot but passively correctable.
  • Stage 3 – Degenerative changes in the subtalar joint and the deformity is fixed
  • Stage 4 – Degenerative changes in the ankle joint


Complications of Posterior Tibial Tendon Dysfunction


Treatment of Posterior Tibial Tendon Dysfunction

Treatment of posterior tibial tendon dysfunction is difficult due to the fact that there is relatively poor blood supply to the area of the tendon just behind the ankle joint, which means it seldom repairs.

Treatment therefore depends on the stage and degree of the deformity.

In the acute stage of the deformity the aim is to rest the tendon and minimise swelling (this may involve using a CAM walker)

When the tendon has settled the aim of treatment is to prevent the traumatic lengthening of the tendon, this is achieved by minimising the activity of the invertor muscles and tendons

  • Orthotics with a rearfoot post –There are a number of different orthotic designs available for flat feet. Most orthotic designs are simply arch supports.
    These are not ideal for the flat foot, often only irritating the arch of the foot.The most appropriate design for Posterior Tibial Tendon Dysfunction is a DHC (Deep Heel Cup) rearfoot orthotic this type of orthotic applies pressure on inside of the heel which increases the arch of the foot without causing discomfort as with most midfoot orthotics.Modulign orthotics are an exciting new way to treat tibialis posterior tendon dysfunction. With the deep heel cup providing superior rearfoot control it is an excellent way to control the triplanar movement of the subtalar joint
    Click here for more information


  • Footwear modification
  • Lace up ankle brace
  • Arizona brace
  • Ankle Foot Orthotic
  • Surgery



The Ankle, Foot and Orthotic Centre’s Northcote Podiatrists can help you with all lower limb complaints, including Ankle Pain. Make an appointment to get your foot and ankle pain under control.

Expert Podiatrists for the treatment of Posterior Tibial Tendon Dysfunction servicing the areas of Northcote, Thornbury, Fitzroy, North Fitzroy, Carlton, North Carlton, Alphington, Fairfield, Brunswick, Coburg and Preston