Posterior Tibial Tendon Dysfunction (PTTD)
Posterior tibial tendon dysfunction (PTTD) is the most common cause of adult-acquired flatfoot. The tendon that supports the arch becomes inflamed, stretched, or torn, leading to gradual arch collapse and pain on the inside of the ankle.
Medically reviewed by Michael G. Lyons, DPM — Board-Certified Foot and Ankle Surgeon
Written and reviewed by the physicians of Foot Health Centers, Hernando & Southaven, MS. Meet our doctors
- Pain and swelling on the inside of the ankle, below the inner ankle bone
- Gradual flattening of the arch
- Difficulty performing a single-leg heel raise
- Outward drift of the heel and forefoot
- Pain that worsens with walking or standing
- Overuse or chronic tendon strain
- Obesity, diabetes, or hypertension
- Inflammatory arthritis
- Acute injury in middle age
- Custom orthotics with medial posting and arch support
- Ankle foot orthosis (AFO) or Arizona brace
- Anti-inflammatory medication
- Physical therapy
- Short period of immobilization for acute flare-ups
Surgery is considered when bracing fails, when the deformity progresses, or for higher-stage flatfoot with rigid changes.
Surgical procedures we perform
Posterior Tibial Tendon Repair
Posterior tibial tendon repair restores the arch-supporting tendon damaged by PTTD or rupture. Often combined with a tendon transfer and bony realignment for the best outcome.
Learn moreFDL Tendon Transfer with Calcaneal Osteotomy
The standard reconstruction for flexible adult acquired flatfoot — the flexor digitorum longus (FDL) tendon is transferred to replace the failed posterior tibial tendon, and the heel bone is realigned with a calcaneal osteotomy.
Learn moreTriple Arthrodesis
Triple arthrodesis fuses three joints of the back of the foot (subtalar, talonavicular, calcaneocuboid) to correct rigid deformity and end-stage arthritis.
Learn moreReconstruction typically requires 6–8 weeks non-weightbearing, then progressive weightbearing in a boot. Most patients return to regular shoes around 3–4 months and full activity by 6–9 months.
Frequently asked questions
Is PTTD the same as a fallen arch?
PTTD is the most common cause of adult-acquired flatfoot. The tendon failure leads to the arch flattening over time.
Can I prevent the flatfoot from getting worse?
Yes — early bracing and orthotics often stop progression. Untreated PTTD leads to rigid deformity that requires more extensive surgery.
Related conditions
Schedule a consultation
Tell us about your posterior tibial tendon dysfunction (pttd) — our team will follow up to schedule.
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Call Foot Health Centers to schedule your visit in Hernando or Southaven.