Posterior Tibial Tendon Dysfunction


Posterior tibial tendon dysfunction (PTTD) is a common problem seen in the foot and ankle of middle aged adults. It is also more commonly seen in the female population. PTTD occurs when the posterior tibial tendon becomes inflamed or torn. As a result, the tendon may not be able to provide stability and support for the arch of the foot, resulting in a flatfoot deformity. Early intervention is key as the longer the condition exists and progresses the more involved treatment will become.


Irritation and dysfunction of the of the tibialis posterior tendon.

Symptoms & Signs

Pain just behind and under the ankle as well and into the arch when the foot is used in weight bearing activities. Swelling may also be noted on the inner aspect of the foot and ankle


Custom foot orthotics, supportive bracing and footwear are commonly used to reduce the irritation and loading of the tibialis posterior muscle / tendon.

Symptoms & Cause

The tibialis posterior muscle is an important muscle that helps raise the heel at propulsion as well as supporting the medial (inner) arch of the foot by reducing excessive pronation. The effected side may begin to swell and become tender behind and under the ankle into the middle of the arch. The foot may change in appearance to a lower or flatter arch, and also “toe-out” more than the effected sign.

When walking, pain may be noted in the arch at push-off or when trying to ascend stairs pushing off the effected side to raise up to the next step.

Pedorthic Treatment

A thorough biomechanical exam to determine range of motion, weakness and static alignment coupled with a gait assessment helps determine the course of conservative treatment.  The amount of foot collapse in cases of PTTD often requires the fabrication of custom orthotics to reduce excessive foot pronation and instability. When the deviation of foot and ankle becomes severe, the use of a brace supporting above the ankle in combination with supportive footwear and custom orthotics is required.

If you are experiencing foot pain or discomfort, you should consult your physician for a proper diagnosis and an appropriate treatment plan.


Your doctor may refer you to OKAPED to see a Canadian Certified Pedorthist for Pedorthic management of your foot pain. This may include orthopaedic footwear, shoe selection guidance, orthotics and/or foot related products such as a metatarsal pad. If you know your condition and want to learn about new products and treatments please give us a call.