Posterior Tibial Tendon Dysfunction

What is Posterior Tibial Tendon Dysfunction?

The posterior tibial tendon passes through the ankle to attach the calf muscle to the bones of the mid foot. It provides stability to the arch and supports the foot while walking. Inflammation or a tear in this tendon may cause pain, and is referred to as Posterior Tibial Tendon Dysfunction (PTTD), sometimes referred to as adult-acquired flatfoot.


Symptoms of PTTD include pain on the inside of the ankle that may be accompanied by swelling. PTTD may cause the heel to shift outwards causing pain on the outside of the ankle as well. Activities such as walking, running, and standing on your toes may aggravate the pain. If treatment is delayed there may be rigidity and the development of arthritis, and you may have trouble walking or wearing shoes.


When you present to the clinic with these symptoms, your doctor will review your medical history and perform a physical examination, testing for pain and swelling, changes in ankle position, flexibility, strength, and range of motion. Imaging tests such as X-ray, MRI, CT and ultrasound scans may be ordered to visualise the tendon and rule out other abnormalities.


PTTD in its early stages may be treated with rest, cold packs, immobilisation, physical therapy, steroid injections and anti-inflammatory medication. Shoe inserts that support the arch may be recommended. Surgery may be necessary if conservative treatments fail, and may include:

  • Tenosynovectomy: The inflamed tendon tissue is cleaned and removed.
  • Tendon transfer: The damaged tendon is replaced by another foot tendon.
  • Arthrodesis: In cases where arthritis has developed, the bones are realigned and fused to form a single bone by removing the cartilage.
  • Osteotomy: Bones of the heel and midfoot may be cut to recreate the arch of the foot.

Related Topics

  • Central west Orthopedics and Sports injuries - Blacktown
  • Fellow of the Royal Australasian College of Surgeons
  • AOA accredited fellowships - AOA | Australian Orthopaedic Association
  • Australian Foot and Ankle Society