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Posterior Tibial Tendon Dysfunction Treatment Plan

by Jaydee Vykoukal, PT, DPT April 13, 2022 0 Comments

feet with insoles

A  proper plan for posterior tibial tendon dysfunction treatment is vital, particularly because the condition can progress if left untreated. The earlier you seek treatment, the easier it will be to manage your symptoms. You also have a greater chance of stopping the condition’s progression to subsequent stages and the onset of the disability and unnecessary suffering.

Untreated PTTD leads to pain, limited mobility, and the risk of arthritis in the foot and ankle. Keep reading to learn more about your treatment options.

PTTD Treatment Your doctor will examine your arches to help determine the best methods of PTTD treatment ( Image Reference).

Non-surgical Treatment Options

Most treatment regimens for PTTD begin with non-surgical approaches. These treatments usually relieve symptoms for most people within 3 to 6 months. However, the length of time for recovery ultimately depends on the severity and your overall health.

Rest and Ice

Even in the early stages, be sure to rest your feet as much as possible, and avoid repetitive or high-impact activities which can cause or exacerbate PTTD symptoms. This gives the tendon time to heal and prevent overuse.

If you miss working out, switch to low-impact activities which don’t cause strain to the foot, like swimming or cycling.

Apply ice packs directly to the painful areas for 20 minutes, three times a day, or after exercising. This helps to reduce inflammation and pain.

Learn about alternating between hot & cold therapy


Over-the-counter or injected medications are available to those with PTTD.

Nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen or naproxen reduce inflammation and pain. Long-term use of NSAIDs has been linked to an increased risk of heart attack, stroke, stomach problems, and kidney problems, according to Harvard Health. Therefore, it’s always important to discuss the use of these medications with your doctor.

Your doctor may suggest injected medications known as corticosteroids. These powerful anti-inflammatories can be injected into the foot or ankle to relieve swelling and help you get back to normal life.

PTTD Orthotics

PTTD Orthotics PTTD orthotics can provide the missing support to your arches & have shown to significantly reduce foot pain ( Image Reference).

Compare Different Types of Insoles

An orthotic device is a term used for any kind of footpad, heel insert, or shoe insert. Orthotics are recommended for most people with PTTD as they provide support to the flattened arch (also known as collapsed arch or pes planus) and reduce direct strain on the posterior tibial tendon.

Shop Orthotics Foot Care

Those with mild PTTD may simply require an over-the-counter orthotic. However, custom-made devices may be necessary for those with moderate to severe PTTD.

Before visiting your podiatrist, do your research.  Custom orthotics  tend to be pricey. 
Are they worth the money?

The type of orthotic device recommended by your doctor will depend on the shape of your foot, the severity of flatfoot deformity, and your symptoms. Available options include:

  • Full-length Orthotics

    Fit fully inside the shoe, providing additional support to the entire foot.

  • Three Quarter Length Orthotics

    Fit into the shoe, providing support to the heel and arch of the foot.

  • Heel Flares

    Help prevent strain on the ankle.

  • Heel Cushions

    Absorb impact from walking or other activities, reducing stress on the heel and ankle.

  • Arch Supports

    Specifically support the arch of the foot. Check the top 6 arch supports here!

PTTD Braces

Moderate to severe cases of PTTD, or people with both PTTD and arthritis, often require the temporary use of an ankle brace to support the foot joints and reduce strain on the tendon. Utilizing a brace early on can reduce the progression of PTTD and help to avoid undergoing any surgical procedures.

Immobilizing Casts or Boots

If the PTTD is severe enough, your doctor may recommend you wear a short cast, ankle-foot orthoses, or special walking boot for 6 to 8 weeks. This helps to immobilize the foot and ankle, giving the tendon time to heal and inflammation to subside.  

Because immobilization leads to the wasting of muscle and a reduction in strength (known as muscle atrophy), it is only recommended if the other treatments listed above fail to achieve the desired results or pain is severe.

Physical Therapy

Exercises that help to strengthen the posterior tibial tendon may be helpful for those with mild or moderate PTTD. Additionally, they can help you to optimize your biomechanical movements of the ankle to reduce the risk of reinjury with an in depth physical examination. They can also help you address any other risk factors or soft tissue damage impeding your healing.

Additionally, if conservative treatment fails, physical therapy may be necessary following immobilization of the foot to help regain muscle mass and strength.

PTTD Surgery & Recovery Time

Surgery is usually considered only when other treatments have failed to relieve symptoms or to halt the progression of the condition. However, for some people - particularly those diagnosed in the advanced stages - surgery may be the only option.

Surgical options vary depending on the stage your PTTD is in, and the symptoms you are experiencing. Your orthopaedic doctor will advise you of your options, and recommend the best approach for your specific case.

Options include:

  • Lengthening of the Calf Muscles or Achilles Tendon

    This is especially helpful for those who have difficulty with ankle flexibility that is exacerbating symptoms of the posterior tibial tendon.

  • Cleaning the Tendon (Debridement)

    Used in mild cases of PTTD, this surgery removes inflamed tissue around the tendon and any other affected local tissues (such as ligaments).

  • Tendon Transfer

    The damaged posterior tibial tendon is removed in this procedure due to insufficiency, and another tendon from the foot (usually from the bottom/plantar side) is used to replace it.

  • Osteotomy

    This involves cutting bones, usually the calcaneus (heel), to change the shape of the foot to a healthier arched shape of the medial foot (determined via x-rays). It is typically used in cases where there is some degree of foot flexibility. In more severe cases, bones may be joined together (fused) to support the arch and stop the flat foot from returning.

  • Joint Fusion (Arthrodesis)

    With severe flattening or in people with arthritis of the foot, joints in the foot are fused to help remove arthritis and return the normal shape to the foot. This will affect the person’s ability to walk normally due to major changes in lower leg mechanics, but can reduce debilitating pain and instability.

The more severe the case of PTTD, the longer the recovery time. It can take up to 12 months to notice improvements in pain levels following surgery.

Complications of surgery include:

  • Failure to completely relieve pain
  • Failure of the bones to fuse together in cases of osteotomy and fusion
  • Wound infection
  • Blood clots

Starting Treatment Off Right

Prompt and accurate treatment is essential for proper foot healing, the earlier the better. Ultimately, providing adequate support to the flattened arch will reduce unnecessary strain on the foot and ankle complex. Make sure you give your foot some rest, use orthotics, and start exercises when you’re ready under the guidance of your doctor and/or physical therapist. From there, you can expect to make gradual progress and get back to life with less foot pain and dysfunction.


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Next Pages:

PTTD Exercises


Jaydee Vykoukal, PT, DPT
Jaydee Vykoukal, PT, DPT

JayDee Vykoukal is a Doctor of Physical Therapy, owner of the healthy habit platform Health Means Wealth, and freelance medical writer. She loves traveling and spending time with her family in nature. Her passion is helping others continue to participate in the activities they love through education and proper exercise.

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