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Flat feet caused by PTTD
Posterior Tibialis Tendon Dysfunction (PTTD)

What is PTTD?

PTTD is the inflammation and/or degeneration of the posterior tibial muscle tendon. This can be a painful condition where structures supporting the arch fail and cause flat feet in adults.

Signs and Symptoms

PTTD is a progressive condition where the signs and symptoms change. Initially pain and swelling track along the tendon on the inside of the foot behind the ankle. As the condition progresses the arch will fall, ankle rolls inward and toes point outward. The pain now moves to the outside of the foot below the ankle.

This condition typically occurs in one foot but can occur in both. PTTD is most common in middle aged women.


The Posterior Tibialis muscle plays an important role in maintaining the arch and preventing the ankle rolling in (pronation). When foot function causes the tendon to be overused, the tendon can lose its ability to function properly. As the condition progresses the ability of the PTT to function properly is diminished.


  • Padding and Strapping
  • Orthotics and appropriate footwear
  • Surgery advice and referral
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