Schedule Your Appointment Today

What Is PTTD?

Posterior Tibial Tendon Dysfunction (PTTD) occurs when the tendon that supports your arch becomes inflamed or torn. As the tendon weakens, the arch collapses, causing pain along the inside of the ankle and foot.

PTTD is one of the most common causes of Adult Flatfoot, especially in patients over 40.

Common Symptoms

• Pain along the inside of the ankle

• Swelling or tenderness on the inner ankle

• Flattening of the arch

• Foot turning outward

• Difficulty standing or walking for long periods

• Trouble fitting into shoes

• Progressive deformity over time

Why PTTD Happens

PTTD often develops due to:

• Overuse

• Flat feet

• High-impact activity

• Obesity

• Previous ankle injuries

• Arthritis

• Age-related tendon degeneration

Without treatment, the tendon continues to weaken — leading to progressive flatfoot and chronic pain.

Stages of PTTD

PTTD progresses through four stages:

Stage 1 — Tendon Inflammation

Pain and swelling along the inner ankle, but the arch is still present.

Stage 2 — Arch Collapse Begins

The foot starts to flatten, and the heel shifts outward.

Stage 3 — Rigid Flatfoot

The arch is fully collapsed and no longer flexible.

Stage 4 — Ankle Arthritis

The deformity affects the ankle joint, causing severe pain and instability.

Early treatment prevents progression to the more advanced stages.

When PTTD Becomes a Problem

You should be seen if you experience:

• Daily arch or ankle pain

• A visibly flattening foot

• Difficulty walking

• Pain that worsens with activity

• Swelling on the inside of the ankle

• Trouble standing for long periods

If your arch collapse is causing ankle weakness, it may be related to Ankle Instability.

Treatment Options

At Orthopedic Foot & Ankle Institute, we offer:

• Custom Orthotics

• Bracing for arch support

• Anti‑inflammatory treatments

• Shockwave therapy (Coming Soon)

• Physical therapy

• PRP injections for chronic tendon damage

For advanced cases, learn more about surgical options on our Reconstructive Surgery page.

Do All Cases of PTTD Require Surgery?

Not always. Many patients improve with early conservative care. However, surgery may be recommended if:

• The arch continues to collapse

• Pain persists despite treatment

• The tendon is torn

• The deformity becomes rigid

• Daily activities are limited

Dr. Sibel offers modern flatfoot reconstruction techniques designed to restore alignment and relieve pain.

Author

Roman Sibel, MD Dr. Roman Sibel, MD is an orthopedic surgeon practicing at Orthopedic Foot & Ankle Institute in Henderson, Nevada. Dr. Sibel specializes in a variety of cutting-edge foot and ankle treatments, including reconstructive surgery, sports medicine, trauma surgery, diabetic care, and laser treatments for removing nail fungus. Dr. Sibel retains active affiliations with numerous Las Vegas hospitals, including Southern Hills Hospital and Medical Center, and St. Rose Dominican Hospital’s multiple campuses throughout Nevada. He also works with several local surgical centers, such as Parkway Surgery Center, Sunset Ridge Surgery Center, and Coronado Surgery Center. Graduating from Pennsylvania State University in University Park, Pennsylvania, Dr. Sibel went on to earn his medical degree from MCP-Hahnemann School of Medicine in Philadelphia. He completed both his internship and residency in orthopedic surgery at Ohio State University in Columbus, Ohio, and finished his foot and ankle fellowship training at the Hospital