Dr. Vaishali Suri (P.T.)
What Is PTTD?
The posterior tibial tendon is the most important tendon for supporting the medial longitudinal arch of the foot. Posterior tibial tendon dysfunction (PTTD) occurs when this tendon becomes inflamed, elongated, or torn, causing the arch to progressively collapse. It is the most common cause of acquired adult flat foot, most prevalent in middle-aged and older women.
Stages of PTTD
Stage 1: Tendinopathy with normal arch height -- pain and swelling along the inner ankle and foot, single-heel-raise test painful. Stage 2: Flexible flat foot -- arch collapses with weight-bearing but corrects when non-weight-bearing. Too-many-toes sign positive. Stage 3: Rigid flat foot -- arch remains collapsed even non-weight-bearing. Stage 4: Ankle involvement with valgus tilt. Stages 1-2 respond very well to physiotherapy and orthotics; Stages 3-4 may require surgery.
Physiotherapy Treatment
Tibialis Posterior Strengthening
Progressive tibialis posterior strengthening is the most important intervention. This involves single-leg heel raises with specific foot positioning to load the tendon through its full functional range. We begin with double-leg and progress to single-leg as tolerated.
Foot Orthotic Support
Medial arch support orthotic or UCBL (University of California Biomechanics Laboratory) orthosis for Stage 2 PTTD. This supports the arch while the tendon heals and strengthens.
Intrinsic Foot Strengthening
Short foot exercises and toe-gripping exercises strengthen the intrinsic foot muscles that assist with arch support.
PTTD Treatment in Faridabad
At Realign Rehab Clinic, NIT-5, Faridabad, early PTTD management prevents progression to surgery. Book your ankle and foot assessment today.