The posterior tibial tendon is one of the most important tendons in the leg. It’s main function is to support the arch when you’re in motion. Posterior tibial tendonitis develops when this tendon becomes inflamed due to injury or overuse.

A more progressive stage of this condition is called Posterior Tibial Tendon Dysfunction or PTTD. In PTTD the ability of the posterior tibial tendon to function properly is impaired resulting in flattening of the foot. This is condition is sometimes referred to as adult-acquired flatfoot because it’s the most common type of flatfoot that develops in adulthood.

Symptoms of Posterior Tibial Tendonitis

posterior tibial tendon dysfunctionPain and swelling can be experienced anywhere along the tendon, from the bottom of the arch to the inside of the ankle and foot while in motion or even standing.  As the foot flattens patients will often show the “too many toes” sign. When you look at the foot from behind you’ll be able to see the big toe. Normally you can only see the fourth and fifth toes from that position.

In later stages of the condition the arch flattens out even more with pain felt on the outside of the foot below the ankle. Both arthritis of the foot and ankle often develop as a result.

Clinical examination often shows pain wtih direct pressure on the tendon, weakness of the muscle, a progressing flatfoot deformity, and inability to raise the heel while standing on the affected foot.  Diagnostic imaging with x-rays, ultrasound and MRI will further evaluate the extent tendon injury and the resultant bone and joint changes.  

Treatment for Posterior Tibial Tendon Dysfunction

Acute Phase Treatment

Acute phase treatment includes the following:

  • rest
  • ice
  • immobilization with a boot
  • anti-inflammatory medication

Treatment for Chronic Inflammation

Chronic inflammation is treated with:


Surgical intervention may be required to repair the degenerated tendon and/or address the underlying faulty mechanics associated with the flat foot.

To learn more about other types of foot and ankle tendonitis:

To learn about other types of heel pain visit:

Dr. Rion Berg
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A podiatrist in North Seattle treating families for over 40 years.