Posterior tibial tendonitis

Posterior tibial tendon dysfunction develops when the tendon supporting your foot's arch becomes weakened or damaged, often leading to a gradual flattening of the foot and changes in the way you walk or stand. Also known as adult flatfoot or PTTD, this condition can affect your balance and comfort during everyday activities. With early evaluation and the right treatment plan, most people find lasting relief.

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Anatomy of the foot and ankle

The posterior tibial tendon runs from your calf, behind the inner ankle bone and into the midfoot. It works like a strong support cable, helping maintain your arch and assisting with push-off when you take a step.

Over time, factors such as repeated strain, age-related wear or added stress from body weight can overload this tendon. As the tendon stretches or tears, the arch may begin to collapse, shifting stress to other parts of the foot and affecting alignment.

Overview

Symptoms

You may want to seek evaluation if you notice:

Aching or swelling along the inside of the ankle or through the arch, often worse after activity
A flattening of the arch that used to be higher
Difficulty rising up onto your toes using only the affected foot
The foot rolling outward or a feeling of instability when walking
Pain that develops on the outside of the ankle as the foot shifts position

These symptoms often start gradually and can worsen over time if the tendon continues to weaken, so early evaluation is important.

Causes

Posterior tibial tendon dysfunction often develops from:

Overuse from prolonged standing, walking or high-impact activities that strain the tendon
Age-related weakening of the tendon, making it less able to support your foot arch
Inflammatory conditions like arthritis or tendinitis that irritate the tendon over time
Extra body weight, which increases stress on the tendon
Flat feet or poor foot alignment that overload the tendon's support role
Improper footwear that lacks arch support or stability for your foot type

Risk factors

Certain factors may increase your likelihood of developing posterior tibial tendon dysfunction, including:

Being overweight, which adds extra stress to the tendon
Having flat feet or an inherited foot shape that alters alignment
Participating in high-impact activities or occupations that require prolonged standing
Having inflammatory conditions such as arthritis
Getting older, since tendons naturally lose some strength and elasticity over time

Having one or more of these risk factors does not mean you'll develop this condition, but it's worth discussing your risk with a specialist if you notice early symptoms.

Diagnosis

Our foot and ankle specialists begin with a thorough exam, checking for tenderness, changes in foot shape and strength, and how well you can stand up on your toes. X-rays help evaluate bone alignment and joint wear. When needed, we may also recommend ultrasound or MRI to take a closer look at the tendon and guide your treatment plan.

A skeletal diagram of a foot with detailed bones and various views of a foot, including toes, soles, and arches.

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