Posterior Tibial Tendon Dysfunction (PTTD)
Posterior tibial tendon dysfunction (adult acquired flatfoot)
Understanding PTTD
The posterior tibial tendon runs behind the bony bump on the inside of your ankle and is the main support for the arch of your foot. When it gets overworked or weakened (posterior tibial tendon dysfunction), the inner ankle aches and the arch can gradually flatten. It''s a common cause of adult flat foot — and the encouraging news is that, especially when caught early, strengthening the tendon and supporting the arch manage it well, which is what this program is built around.
The reassuring outlook
Early-stage PTTD responds well to strengthening (especially heel raises and inversion) combined with a supportive shoe or arch insert that offloads the tendon. Catching and treating it early is what keeps the arch supported. Most people improve their pain and function with this conservative approach.
What you might be feeling
PTTD often brings pain and swelling along the inside of the ankle and arch, worse with standing and activity, tired or achy feet, and sometimes a sense that the arch is flattening or that it''s hard to rise up onto the toes on that one foot. It usually eases as the tendon strengthens and the arch is supported. If anything new or unexpected comes up, or you''re unsure how you''re doing, your care team is the best place to check.
The key: strengthen the tendon + support the arch
Two things work together: strengthening the posterior tibial tendon (heel raises, especially single-leg, and turning the foot inward against resistance) rebuilds its support; and a supportive shoe or arch insert (orthotic) offloads the tendon so it isn''t overworked while it recovers. The arch support is a genuinely important part of this — not optional.
How this program is built
It starts with calf stretching and heel raises, builds toward single-leg heel raises (the key strengthener) and inversion work, plus arch-supporting toe exercises and balance. Pair it with a supportive shoe or insert. Progress the heel raises as the tendon tolerates; ease off anything that sharply provokes the inner ankle.
Staying comfortable day to day
A supportive shoe with good arch support — or a custom or off-the-shelf orthotic — is one of the most effective measures; it offloads the tendon all day. Ease off prolonged standing and high-impact activity while it settles, and build back gradually.
When it flares
When it''s more bothersome: ease off the standing and impact for a few days, make sure your arch support is doing its job, use ice, and a short anti-inflammatory course if appropriate for you. Then ease back into the strengthening. A flare doesn''t undo your progress.
Tracking how you''re doing
Your quick daily check-in gives you and your care team a shared view of how things are trending — a simple way to see progress and keep your care team in the loop. It is not a monitoring or warning system.
This guide is general education, not medical advice, and doesn't replace evaluation by a licensed provider. For urgent symptoms, contact your care team or call 911.