Posterior Tibial Tendon Dysfunction: Causes, Symptoms, and Modern Solutions

Posterior tibial tendon dysfunction is a common but often misunderstood cause of foot pain and instability. If you’re struggling with discomfort along the inside of your ankle or noticing changes in your arch, understanding this condition is the first step toward effective treatment and lasting relief. At Wasatch Foot & Ankle Institute, we’re committed to helping you regain your mobility and confidence with the latest diagnostic and treatment options.

What Is Posterior Tibial Tendon Dysfunction?

The posterior tibial tendon runs along the inside of your ankle and foot, connecting the calf muscle to bones in the midfoot. Its main job is to support the arch and stabilize your foot as you walk or run. When this tendon becomes inflamed, overstretched, or torn, it can no longer do its job effectively. This leads to a gradual flattening of the arch, pain, and sometimes even difficulty walking.

Why Does This Happen?

There are several reasons why the posterior tibial tendon might become damaged. Overuse from activities like running, hiking, or standing for long periods can strain the tendon. Injuries such as ankle sprains, or underlying conditions like obesity, diabetes, or inflammatory arthritis, can also increase your risk. Sometimes, the tendon simply weakens with age, especially if you have naturally flat feet.

Recognizing the Symptoms

Early signs of posterior tibial tendon dysfunction often include pain and swelling along the inside of the ankle or foot. You might notice that your arch looks flatter than usual, or that your foot rolls inward more when you walk. As the condition progresses, standing on tiptoe or walking long distances can become difficult. Some people experience ankle instability or even develop secondary problems like shin splints or knee pain due to changes in their gait.

Ignoring these symptoms can lead to chronic pain and more severe deformity, so it’s important to seek help early.

How Is It Diagnosed?

Diagnosis starts with a thorough physical exam. Your provider will look for swelling, tenderness, and changes in your arch. You may be asked to stand on one foot or walk so your gait can be observed. Imaging tests like MRI or ultrasound are often used to confirm the diagnosis and assess the extent of tendon damage. These tools help your provider determine whether conservative care or surgical intervention is the best path forward.

Conservative Treatments: The First Line of Defense

Most cases of posterior tibial tendon dysfunction can be managed without surgery, especially when caught early. At Wasatch Foot & Ankle Institute, we often recommend a combination of the following:

• Custom orthotics: Special shoe inserts support your arch and reduce strain on the tendon.

• Bracing: Ankle braces can provide extra stability and limit painful movements.

• Physical therapy: Targeted exercises strengthen the muscles around the tendon, improve flexibility, and restore normal foot mechanics.

• Activity modification: Reducing high-impact activities and switching to low-impact options like swimming or cycling can help the tendon heal.

• Anti-inflammatory medications: These can reduce pain and swelling, making it easier to participate in rehab.

Consistency is key. Many patients see significant improvement with these strategies, especially when they stick to their prescribed plan.

When Is Surgery Needed?

If conservative treatments don’t provide relief after several months, or if the tendon is severely torn, surgery may be necessary. Surgical options range from cleaning up inflamed tissue (debridement) to tendon repair or even tendon transfer procedures. The goal is always to restore stability and function so you can return to your normal activities. Recovery from surgery involves a period of immobilization followed by physical therapy, but most patients experience lasting improvement.

Innovative Therapies: What’s New?

Advances in regenerative medicine are opening new doors for tendon healing. Platelet-rich plasma (PRP) injections, which use your own blood to promote tissue repair, are showing promise for chronic tendon injuries. Stem cell therapies and extracellular matrix products are also being studied as ways to enhance recovery and reduce the need for surgery. At Wasatch Foot & Ankle Institute, we stay at the forefront of these developments to offer our patients the best possible care.

Rehabilitation and Prevention

Rehabilitation doesn’t end when the pain subsides. Ongoing exercises to strengthen your foot and ankle, improve balance, and maintain flexibility are essential for preventing recurrence. Gait training and footwear modifications can also make a big difference. Supportive shoes with proper arch support and cushioning are a must, especially if you have a history of foot problems.

The Emotional Side of Recovery

Dealing with foot pain and limited mobility can be frustrating and isolating. It’s normal to feel discouraged, especially if recovery takes longer than expected. Staying connected with your care team, setting small goals, and celebrating progress can help you stay motivated. If you’re struggling emotionally, don’t hesitate to reach out for support—your mental health is just as important as your physical recovery.

Looking Ahead: The Future of Tendon Care

Research into genetic factors and new technologies like wearable devices and 3D-printed orthotics is rapidly changing the landscape of tendon care. Personalized treatment plans based on your unique anatomy and lifestyle are becoming the standard. At Wasatch Foot & Ankle Institute, we’re excited to bring these innovations to our patients as they become available.

FAQ: Posterior Tibial Tendon Dysfunction

What causes posterior tibial tendon dysfunction?

Common causes include overuse, injuries, obesity, diabetes, and age-related tendon degeneration.

How do I know if I have posterior tibial tendon problems?

Look for pain and swelling along the inside of your ankle, flattening of the arch, and difficulty standing on tiptoe or walking long distances.

Can this condition be treated without surgery?

Yes, most cases improve with custom orthotics, bracing, physical therapy, and activity modification. Early intervention is key.

Are there advanced treatments available?

Yes, options like PRP injections and regenerative therapies are available for certain cases. Your provider can discuss what’s right for you.

How can I prevent future problems?

Maintain a healthy weight, wear supportive shoes, and follow a regular exercise program to keep your feet strong and flexible.

For more information or to schedule an appointment, visit Wasatch Foot & Ankle Institute. Our team is here to help you get back on your feet—literally and figuratively.