Fallen arches can often be a common and painful problem. The condition is referred to as Posterior Tibial Tendon Dysfunction or PTTD. The posterior tibial tendon serves as one of the major supporting structures of the foot , helping it to function while walking. This tendon goes behind the inside of your ankle and attaches in the middle of your foot, helping to create your arch.When changes in the tendon happen, it impairs its ability to support the arch and results in the flattening of the foot. It is often called adult acquired flatfoot because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it is not treated early.


Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities such as running, walking, hiking, or climbing stairs. The tendon can become stretched out over time or even torn. This leads to strain on the inside of the foot and ankle and results in a flatfoot deformity that can cause pain and make the foot appear to be flat on the bottom.


The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. Patients might also experience back and/or leg pain associated with the loss of the arch. As the condition progresses, the symptoms will change. For example, when PTTD initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen. Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. At this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably, and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.

Nonsurgical Treatment

Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery, and progression of your condition may be stopped.

In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle , and increasing limitations on walking, running, or other activities.
In many cases of PTTD , treatment can begin with nonsurgical approaches that may include:
  • Orthotic devices or bracing. To give your arch the support it needs, Dr. Kylin Kovac may provide you with an ankle brace or a custom orthotic device that fits into the shoe.
  • Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight bearing for a while.
  • Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
  • Shoe modifications. Dr. Kovac may advise changes to your shoes and may provide special inserts designed to improve arch support.

When is Surgery Needed?

In cases of PTTD that have progressed substantially or have failed to improve with nonsurgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Dr. Kovac will determine the best approach for you.

If you have any foot or ankle issues that are bothering you, please contact Dr. Kylin Kovac at Idaho Foot and Ankle Center! From routine checkups to treatments for surgery, we are equipped to handle all your podiatric needs!

Some content provided by The ACFAS.