PTTD Series
Part 1 PTTD What is It?
Let’s look at Posterior Tibial Tendon Dysfunction (PTTD)!
Posterior Tibial Tendon Dysfunction (PTTD) is a condition affecting the posterior tibial tendon, a key stabilizing structure that runs along the inside of the ankle and supports the arch of the foot. This tendon plays a critical role in controlling inward rolling (pronation), maintaining foot alignment, and supporting efficient walking and running mechanics. When the tendon becomes inflamed, overstretched, or damaged, the foot’s natural structure and movement patterns can be compromised, leading to pain, instability, and functional limitations.
PTTD often develops gradually, making early detection challenging. Initial symptoms may include mild pain, swelling, or tenderness along the inner ankle, fatigue during walking or standing, or a subtle feeling of instability. Because discomfort may improve with rest, many individuals delay seeking care. Over time, continued tendon dysfunction can lead to visible structural changes like hindfoot valgus, forefoot abduction, collapsing arch, and difficulty pushing off during gait. It’s commonly classified into 4 stages. Stage I involves tendon irritation without changes in foot shape, Stage II includes a flexible flatfoot with hindfoot valgus and forefoot abduction, Stage III presents as a stiff, fixed flatfoot, and Stage IV progresses to ankle involvement with worsening deformity.
Management of PTTD commonly includes supportive footwear and orthotics to address both symptoms and underlying mechanics. Shoes with a stable sole, firm heel counter, and proper arch support help limit excessive motion and reduce strain on the tendon. Orthotics further support the arch, improve alignment, and redistribute forces across the foot. By improving foot mechanics, orthotics reduce stress on the tendon and help the foot maintain a more natural alignment during daily activities. When combined with supportive footwear, orthotics can help reduce pain along the inner ankle, improve foot and ankle stability, enhance walking and functional movement, and slow the progression of tendon dysfunction.
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