The posterior tibial tendon has the important function of supporting the arch of the foot while a person walks. Posterior tibial tendon dysfunction (PTTD) occurs when there are changes and inflammation to the tendon, impairing its ability to support the arch. As the condition progresses, micro trauma to the tendon causes it to lengthen, resulting in the arch collapse and flatten the foot.

This is often termed “adult acquired flatfoot” as it is a progressive condition that is acquired as an adult. Initially, the foot changes are flexible and easy to treat due to its reproducibility to a normal state. With time, the foot accommodates to these abnormal changes and starts to stiffen into a fixed position. Your podiatrist will be able to assess the severity of the condition and treat the condition accordingly.



Adult acquired flat feet is a slow and progressive condtion where the main tendon (posterior tibial tendon) over lengthens, resulting in the arch to collapse and the foot to become flattened. The most common cause of this condition is overuse of the tendon, resulting in symptoms of pain, swelling and difficulty walking. The symptoms usually occur with activity that has an increased pull of the tendon such as running, hiking or climbing stairs.


  • Pain to inside arch and along tendon
  • Pain to other sites of the foot and ankle
  • Swelling to foot
  • Flattening of arch
  • Limited joint motion due to arthritis


The key to treating patients with PTTD and acquired flat feet is early recognition. As mentioned, the condition is progressive and involves continuous flattening of the arch with a transition from flexible to a rigid and stiff state. The earlier treatment is started, the better to prevent worsening of the condition. This can be very important in prevention of major reconstructive surgery.

Conservative options to treat PTTD include:

  • Prescription medication such as anti-inflammatories or oral steroids
  • Orthotics with heel modifications
  • Custom orthotics
  • Ankle and foot braces
  • Fracture boot
  • Physical therapy
  • Shoe modifications

At Premier Foot & Ankle, we’re proud to offer custom molded orthotics contoured specifically for your foot structure. The mold is through a 3D scan and can be modified to specifically treat your foot’s deformity. Custom orthotics are often covered by insurance and will last for 3-5 years. Our cash prices are also very affordable! Ask your podiatrist if custom orthotics are best for you!

In cases where PTTD is severe and has progressed to a stiff, rigid or arthritic state, surgery may be required. Radiographs and other advanced imaging will be required for surgical planning. The operation is a major reconstruction, but will be essential to reforming the arch and getting you back on your feet!

If you are exhibiting early indication of pain or discomfort, visit your podiatrist at Premier Foot & Ankle for care!


Contact Form

  • This field is for validation purposes and should be left unchanged.