Posterior Tibial Tendon Dysfunction

Posterior tibial tendon dysfunction (PTTD) occurs when the posterior tibialis tendon—located behind the inner ankle bone—becomes irritated or weakened. This tendon plays a key role in supporting the arch of the foot during walking. While it can be injured suddenly following a fall or accident, PTTD more commonly develops gradually due to overuse or repetitive strain. As the tendon weakens, it becomes less effective at supporting the arch, allowing the foot to flatten and increasing stress on surrounding tissues.

Symptoms often include pain or swelling along the inside of the ankle and foot that worsens with prolonged standing or walking, running, stair climbing, standing on tiptoe, or navigating uneven surfaces. Early identification and treatment are important to slow or prevent progression. At Trenton Integrative Health Centre, care focuses on reducing tendon strain, supporting the arch, and restoring strength and function through conservative, evidence-informed approaches.

Understanding Posterior Tibial Tendon Dysfunction

When arch support weakens, and foot strain builds over time

Pain along the inside of the ankle or a gradual flattening of the foot can be concerning—especially when it begins to interfere with walking or standing comfortably. Posterior tibial tendon dysfunction is a common but often overlooked cause of these symptoms and tends to develop slowly rather than from a single injury.

At Trenton Integrative Health Centre, we focus on identifying contributing factors early and supporting recovery through conservative, individualized care.

What Is Posterior Tibial Tendon Dysfunction?

The posterior tibial tendon runs behind the inner ankle bone and plays a critical role in lifting and supporting the arch of the foot during walking. When this tendon becomes irritated, overstretched, or weakened, it can no longer perform its role effectively.

As a result:

• The arch of the foot may gradually collapse
• Stress on the tendon and surrounding structures increases
• Symptoms may progress if not addressed early

PTTD is often associated with increased activity levels, repetitive strain, or training on hard surfaces, but it can affect anyone who spends long periods on their feet.

Common Symptoms

Symptoms may include:

• Pain or swelling along the inside of the ankle or foot
• Discomfort that worsens with prolonged standing or walking
• Pain during running, stair climbing, or standing on tiptoe
• Difficulty walking on uneven surfaces
• A gradual flattening of the arch on the affected side

Symptoms often start mildly and worsen over time if the tendon continues to be overloaded.

Why Does Posterior Tibial Tendon Dysfunction Develop?

PTTD usually develops due to a combination of:

• Repetitive overuse or increased training volume
• Insufficient recovery between activities
• Prolonged standing or walking on hard surfaces
• Inadequate foot support
• Weakness or fatigue in the supporting muscles of the foot and ankle

As the tendon weakens, the collapse of the arch further increases strain, creating a cycle that can accelerate symptoms.

How Posterior Tibial Tendon Dysfunction Is Managed at TIHC

Care at Trenton Integrative Health Centre focuses on reducing tendon overload while restoring strength and support.

Management may include:

• Hands-on therapies to reduce irritation and improve mobility
• Targeted exercises to strengthen the posterior tibial tendon and supporting muscles
• Activity modification to allow healing while maintaining fitness
• Recommendations for arch supports or custom orthotics to reduce strain on the tendon

Low-impact activities such as stationary cycling, elliptical training, or swimming are often encouraged during recovery.

Supporting Your Recovery

You may be advised to:

• Temporarily limit weight-bearing or high-impact activities
• Avoid prolonged standing or walking during flare-ups
• Wear supportive footwear consistently
• Perform prescribed exercises regularly to rebuild tendon strength

Home exercises play a central role in recovery and long-term foot health.

What to Expect

When addressed early, posterior tibial tendon dysfunction often responds well to conservative care. Many people can reduce pain, improve foot support, and return to daily activities comfortably without surgery.