When we think about foot pain or arch problems, we often picture flat feet or plantar fasciitis. But one of the most overlooked—and potentially serious—conditions is Posterior Tibial Tendon Dysfunction (PTTD). Often called the “silent arch killer,” PTTD can sneak up on you, gradually flattening your foot and affecting everything from your gait to your knees and back.

At Foot & Ankle Associates of Southern NH, we see many patients who come in too late—after their arches have already collapsed. The good news? If caught early, PTTD is highly treatable.

What Is Posterior Tibial Tendon Dysfunction?

The posterior tibial tendon is a key structure that supports the arch of your foot and helps you walk. It connects the calf muscle to bones in the foot and plays a crucial role in stabilizing your step.

In PTTD, this tendon becomes inflamed, overstretched, or torn—leading to a progressive collapse of the arch. This condition can result in flatfoot deformity, chronic pain, and difficulty walking if left untreated.

What Causes PTTD?

PTTD often develops over time, especially in:

• Adults over age 40

• Women more than men

• People who are overweight or have high-impact lifestyles

• Individuals with flat feet or poor biomechanics

• Athletes or those with repetitive stress on the foot (e.g., long-distance walking or running)

Sometimes the onset is sudden—after an ankle injury or fall—but most cases develop slowly, making it harder to catch early.

Early Warning Signs to Watch For

Recognizing PTTD early is key to preserving foot function. Watch for these symptoms:

✅ Pain or swelling along the inside of the ankle or foot
✅ Flattening of the arch, sometimes just in one foot
✅ Trouble standing on your toes
✅ Rolling in of the ankle (overpronation)
✅ Fatigue or aching after long periods of standing or walking
✅ Difficulty fitting into shoes due to foot shape changes

If you're experiencing any of these symptoms, don’t wait—it’s much easier to manage PTTD in its early stages than to correct a collapsed arch later on.

Why Early Treatment Matters

Left untreated, PTTD can lead to rigid flatfoot, arthritis in the foot and ankle joints, and chronic pain. Patients may eventually need reconstructive surgery or even joint fusion if the condition becomes severe.

Early treatment can prevent long-term damage and often avoids the need for surgery. Interventions may include:

• Custom orthotics or braces to support the arch

• Physical therapy to strengthen surrounding muscles

• Anti-inflammatory treatments to reduce pain and swelling

• Activity modification to reduce tendon strain

• Shoe recommendations that provide adequate arch and heel support

In more advanced cases, surgical intervention may be required to repair or reconstruct the tendon and restore proper alignment.

Real Care for Real Results

At Foot & Ankle Associates of Southern NH, we specialize in identifying early-stage foot conditions and offering personalized treatment plans. If you're noticing changes in your arch, balance, or comfort when walking, don’t ignore it.

PTTD may be silent—but it doesn’t have to be permanent.

Schedule an Evaluation Today

If you suspect you may be experiencing Posterior Tibial Tendon Dysfunction, early action is your best defense. Book an appointment with our team and let’s protect your arches before it's too late.