Pain in the Arch of Your Foot? Posterior Tibial Tendon Dysfunction

Posterior Tibial Tendon Dysfunction Acquired Adult Flat Foot Treatment

Pain in the Arch of Your Foot: Expert Assessment & Treatment for Posterior Tibial Tendon Dysfunction

Pain Along the Inside of Your Ankle or a Collapsing Arch?

Pain along the inside of your ankle, a collapsing arch or adult acquired flat foot may be signs of Posterior Tibial Tendon Dysfunction (PTTD). It is one of the most common causes of progressive arch collapse in adults and, if left untreated, symptoms can gradually worsen over time.

The condition develops when the posterior tibial tendon, which supports the arch of the foot, becomes weakened, stretched or damaged. Many people initially assume they have simply strained their foot or that a flattening arch is a normal part of ageing.

At Callen Olive, our specialist podiatrists diagnose and treat Posterior Tibial Tendon Dysfunction, helping to relieve pain, improve foot function and support long-term mobility through personalised treatment plans.

You're Not Alone

PTTD most commonly affects adults over the age of 40, although it can occur at any age.

We regularly assess and treat people who are finding everyday activities increasingly difficult because of pain, fatigue and changes in foot shape.

Many people come to us because they are:

  • Struggling to walk longer distances

  • Finding standing increasingly uncomfortable

  • Becoming less active

  • Losing confidence in their mobility

  • Concerned that their foot is becoming flatter

  • Worried they may eventually need surgery

You are not alone.

Our experienced clinicians understand how worrying it can be to notice changes in your foot shape and are here to help you understand your condition and explore the most appropriate treatment options.

What Is The Posterior Tibial Tendon?

The posterior tibial tendon runs along the inside of the ankle and attaches to structures within the arch of the foot.

It plays an important role in:

  • Supporting the arch of the foot

  • Controlling foot movement

  • Stabilising the foot during walking

  • Helping propel the body forwards during movement

Every step you take places demand through this tendon.

When the tendon becomes overloaded or weakened, it may struggle to perform these functions effectively.

Over time, this can lead to progressive flattening of the foot and changes in the way you walk.

What Does Posterior Tibial Tendon Dysfunction Feel Like?

People commonly describe:

  • Pain along the inside of the ankle

  • Aching in the arch of the foot

  • Swelling around the tendon

  • Pain during walking

  • Foot fatigue

  • Reduced walking endurance

  • Reduced balance and stability

  • Difficulty standing on tiptoe

  • Progressive flattening of the foot

  • Changes in the shape of the foot

Many people notice symptoms gradually worsening over months or years.

How Can PTTD Affect Everyday Life?

Posterior Tibial Tendon Dysfunction can affect almost every activity involving standing and walking.

Many people find themselves:

  • Avoiding long walks

  • Struggling to stand comfortably for prolonged periods

  • Becoming less active

  • Losing confidence in their mobility

  • Finding holidays and days out increasingly difficult

  • Feeling frustrated by changes in the appearance of their feet

For some people, the impact on comfort, independence and quality of life can be significant.

Can Flat Feet Develop In Adulthood?

Yes.

This is one of the biggest misconceptions surrounding flat feet.

Many people believe they would have known if they had flat feet because they would have always had them.

However, Posterior Tibial Tendon Dysfunction is one of the most common causes of adult-acquired flat feet.

As the tendon weakens, it may become less able to support the arch, leading to progressive flattening of the foot over time.

This is one reason why early assessment is so important.

What Causes Posterior Tibial Tendon Dysfunction?

There is rarely one single cause.

Several factors may contribute to excessive strain through the tendon.

Ageing

PTTD is more common in adults over the age of 40 as tendons generally become less resilient and recover more slowly.

Foot Biomechanics

Certain foot types may place increased strain on the tendon.

Previous Injury

Past injuries may weaken the tendon and increase future risk.

Weight-Bearing Activities

Occupations and lifestyles involving prolonged standing or walking may increase loading through the tendon.

Existing Flat Feet

People with flatter foot structures may be at increased risk of developing symptoms.

Systemic Health Conditions

Certain medical conditions can affect tendon health and increase susceptibility to injury.

Often, multiple factors are involved rather than one single cause.

Understanding The Stages Of PTTD

Posterior Tibial Tendon Dysfunction is often classified into stages depending on tendon damage and changes in foot posture.

Stage One

  • Tendon irritation and inflammation

  • Pain and swelling

  • Arch remains relatively normal

  • No significant deformity

This stage often represents the best opportunity to prevent progression and preserve normal foot structure.

Stage Two

  • Tendon weakening

  • Progressive flattening of the arch

  • Flexible flat foot deformity

  • Difficulty performing a single-leg heel raise

Many people first seek treatment during this stage.

Stage Three

  • Significant arch collapse

  • More rigid flat foot deformity

  • Arthritis may begin developing within the foot joints

  • Reduced mobility

Stage Four

  • Advanced deformity

  • Arthritis affecting the ankle joint

  • Significant functional limitations

  • More complex treatment requirements

Understanding the stage of the condition helps guide treatment recommendations and future planning.

Why Early Assessment Matters

Posterior Tibial Tendon Dysfunction is typically a progressive condition.

Many people initially notice mild discomfort along the inside of the ankle or arch and assume they simply have flat feet, a minor strain or a normal part of ageing.

Unfortunately, delaying treatment may allow the tendon to weaken further, leading to increasing flattening of the foot and greater strain on surrounding joints and structures.

As the condition progresses, it can become increasingly difficult to manage and may contribute to:

  • Permanent changes in foot posture

  • Arthritis

  • Reduced mobility

  • Reduced walking tolerance

  • Loss of confidence and independence

Early assessment and treatment may help:

  • Reduce pain

  • Support the tendon

  • Preserve the arch

  • Slow progression of the condition

  • Maintain mobility

  • Reduce the risk of long-term joint damage

  • Reduce the likelihood of surgical intervention

At Callen Olive, we believe early diagnosis and proactive management provide the best opportunity to preserve foot function and support long-term quality of life.

How We Assess Posterior Tibial Tendon Dysfunction

Assessment begins by understanding your symptoms and how they are affecting your everyday life.

This may include:

  • Clinical examination

  • Tendon assessment

  • Foot posture evaluation

  • Biomechanical assessment

  • OptoGait gait analysis

  • Footwear assessment

  • Functional testing

Where appropriate, diagnostic imaging may also be recommended.

By understanding why symptoms have developed, we can create a personalised treatment plan tailored to your individual needs and goals.

Your Personalised Treatment Plan

Treatment depends on the stage of the condition, symptom severity and your individual goals.

Management may include:

Footwear Advice

Appropriate footwear can often significantly improve support and reduce unnecessary strain through the tendon.

Custom Foot Orthotics

Custom Foot Orthotics are often one of the most important treatment options for Posterior Tibial Tendon Dysfunction.

They may help support the arch, improve foot function and reduce excessive loading through the tendon.

Rehabilitation Exercises

Targeted strengthening and rehabilitation programmes may help improve tendon capacity, lower limb strength and movement efficiency.

Activity Modification

Temporary adjustments to activity levels may help reduce tendon irritation whilst supporting recovery.

Bracing

In some cases, additional support may be beneficial depending on the severity and stage of the condition.

Surgical Referral

Where symptoms continue to progress despite conservative management, surgical intervention may occasionally be considered.

If appropriate, we can discuss referral to a trusted foot and ankle surgeon.

Our goal is not simply to reduce pain today, but to preserve long-term foot function and help you remain active and independent.

Why Doesn't Rest Alone Always Work?

Many people assume they simply need to rest and wait for symptoms to settle.

Whilst temporarily reducing aggravating activities may sometimes be appropriate, rest alone rarely addresses the underlying causes of PTTD.

Successful treatment often involves addressing factors contributing to excessive strain through the tendon, including:

  • Foot biomechanics

  • Footwear

  • Tendon strength

  • Lower limb function

  • Activity levels

  • Progressive arch collapse

Our objective is not simply to reduce symptoms today but to help reduce the likelihood of progression in the future.

Can I Continue Walking With PTTD?

In many cases, yes.

Remaining active is often beneficial for both physical and mental wellbeing.

However, the amount and type of activity that is appropriate will depend on the severity and stage of the condition.

For some people, simple adjustments to footwear and support may allow them to remain active and comfortable.

For others, temporary modifications may be necessary whilst symptoms settle.

Our goal is to help you remain as active and independent as possible whilst supporting recovery and long-term foot health.

Why Choose Callen Olive?

We Care.

Posterior Tibial Tendon Dysfunction is often overlooked during the early stages when treatment can be most effective.

Many people come to us worried about worsening pain, collapsing arches and losing confidence in their mobility.

Our experienced clinicians combine expert assessment, biomechanics and personalised treatment planning to identify the condition early and create treatment plans designed to maintain comfort, mobility and long-term foot function.

Because caring for your feet isn't simply about reducing pain. It's about helping you move with comfort, confidence and ease.

Healthy Feet. Healthy Body. Healthy Mind.

Treatment Fees

No two patients are the same.

That's why every treatment plan is tailored to your individual needs, lifestyle and goals. Following your assessment, your clinician will explain the treatment options available and help you choose the most appropriate pathway to achieve the best possible outcome.

Our focus is always on helping you achieve the best possible outcome for your comfort, mobility and long-term wellbeing.

New Patient Biomechanics Assessment: £180
New Patient Biomechanics Assessment with Principal Podiatrist: £225

Our team will support you throughout every stage of your recovery to ensure you feel informed, reassured and cared for.

If you are unsure which appointment is most suitable, our Patient Care Team will be happy to help.

Call us on +44 333 305 8347.

Related Conditions

  • Adult Flat Feet

  • Plantar Fasciitis

  • Achilles Tendinopathy

  • Arthritis

  • Hallux Rigidus

Related Treatments

  • Biomechanical Assessment

  • OptoGait Gait Analysis

  • Custom Foot Orthotics

Learn More

  • Active Ageing & Foot Health

  • Walking For Wellbeing

  • Running & Foot Health

  • Falls Prevention & Foot Health

Frequently Asked Questions

Can Flat Feet Develop In Adulthood?

Yes. Posterior Tibial Tendon Dysfunction is one of the most common causes of adult-acquired flat feet and progressive arch collapse.

Will My Arch Collapse Continue To Worsen?

Not necessarily. Early assessment and appropriate treatment may help support the tendon and slow progression of the condition.

Can Orthotics Help PTTD?

For many people, Custom Foot Orthotics can help support the arch, improve foot function and reduce excessive strain through the tendon.

Do I Need Surgery?

Most people do not require surgery. However, surgical intervention may occasionally be considered in more advanced cases that have not responded to conservative management.

Can I Continue Walking With PTTD?

In many cases, yes. Remaining active is often beneficial, although activity levels and footwear may need to be modified depending on symptoms and the stage of the condition.

Is PTTD The Same As Having Flat Feet?

No. Many people with PTTD develop flat feet as a result of the tendon becoming weakened and less able to support the arch.

Ready To Move More Comfortably Again?

Pain along the inside of your ankle and a flattening arch should not be ignored.

Whether your symptoms have recently developed or have been affecting you for some time, our experienced team is here to help.

Book your assessment today and take the first step towards moving with comfort, confidence and ease.

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