About posterior tibial tendon dysfunction
The posterior tibial tendon runs behind the inner ankle bone and attaches under the arch. It is one of the main supports of the arch, and it helps you rise onto your toes. When this tendon becomes overloaded or starts to break down, the arch can gradually flatten.
This condition, also called adult-acquired flatfoot, is most common in middle-aged and older adults, particularly women, and in people with higher body weight, diabetes, or high blood pressure. It usually starts gradually rather than with a single injury.
Early stages are often very treatable. If the tendon keeps weakening, the foot can become more flat and stiff over time, which is why an early, accurate diagnosis matters.
Common symptoms
- Pain and swelling along the inner ankle and arch
- A gradually flattening arch or a foot that rolls inward
- Difficulty or pain when rising up on the toes of one foot
- Pain that worsens with walking, standing, or stairs
- Pain on the outer ankle in later stages as the foot shifts
Common causes and risk factors
- Gradual overload of the tendon from walking, running, or standing
- Flat feet or a foot that rolls inward
- Higher body weight, diabetes, or high blood pressure
- A prior ankle injury or steroid injection near the tendon
How we diagnose it
Our physicians examine your arch and foot alignment while you stand, check whether you can rise up on the toes of one foot, and test the strength of the tendon. Diagnostic ultrasound at the exam table shows whether the tendon is thickened, degenerated, partly torn, or surrounded by fluid. Standing X-rays may be ordered to assess foot alignment and arthritis, and an MRI is referred when a larger tear is suspected.
How Propel treats posterior tibial tendon dysfunction
Treatment usually begins with support for the arch through custom or over-the-counter orthotics, supportive shoes, or an ankle brace, sometimes with a short period in a walking boot for a very painful tendon. A progressive tendon loading program strengthens the posterior tibial tendon and the muscles of the foot and calf. We also adjust walking, standing, and exercise volume while the tendon recovers.
When pain persists despite good support and rehab, shockwave therapy and ultrasound-guided PRP may help the tendon heal. If the flatfoot has become rigid, arthritis has developed, or the tendon is badly torn, surgery may be the better option, and we refer to trusted orthopedic foot and ankle surgeons.
What to expect at your visit
- 1.
We listen first
Your visit opens with a real conversation: how the problem started, what you have already tried, and the activity you want back.
- 2.
Exam and in-office ultrasound
A hands-on exam, then ultrasound at the exam table, often while you move, so your physician can see the tendon, joint, or nerve involved.
- 3.
A clear diagnosis and plan
You leave knowing what is wrong and what your options are, from strength-based rehab to procedures, and why we recommend each one.
- 4.
Treatment and follow-through
Most procedures happen here in the office. We coordinate with your physical therapist and check progress against the goals you set.
Questions about posterior tibial tendon dysfunction
- Can my flat foot get better without surgery?
- In the earlier stages, when the foot is still flexible, many people do well with orthotics or bracing and a strengthening program. Surgery is more often considered when the foot has become stiff or the tendon is severely damaged.
- Do I need custom orthotics?
- Some people do well with a quality over-the-counter arch support, while others benefit from a custom orthotic or brace. We recommend the level of support based on your foot shape, symptoms, and activity.
- Why does it hurt to stand on my toes on one foot?
- The posterior tibial tendon helps lift the heel and lock the foot as you rise onto your toes. When the tendon is weak or damaged, that single-leg heel raise becomes painful or difficult, which is one of the key signs we check.