What Is Posterior Tibial Tendonitis?
Posterior tibial tendonitis (PTT) — also called posterior tibial tendon dysfunction (PTTD) — is inflammation and degeneration of the posterior tibial tendon, the primary dynamic supporter of the medial arch of the foot. This tendon runs from the calf muscle, around the back of the medial malleolus (the inner ankle bone), and attaches to multiple bones of the midfoot. It is the primary dynamic supporter of the medial arch of the foot, and without its support, the arch progressively collapses.
PTTD is the leading cause of adult-acquired flat foot deformity — a progressive condition that, when left untreated, can lead to significant foot and ankle disability requiring surgical reconstruction. Early diagnosis and treatment are critical.
Anatomy and Function
The posterior tibial tendon has three primary functions:
- Supination of the subtalar joint — locking the midfoot into a rigid lever for push-off during walking
- Inversion of the foot — turning the foot inward
- Dynamic arch support — maintaining the medial longitudinal arch under load
When the tendon is dysfunctional — whether from acute injury, chronic overuse, or degenerative change — all three functions are compromised, leading to progressive flat foot deformity.
Stages of Posterior Tibial Tendon Dysfunction
- Stage I: Tendon is intact but inflamed. Normal arch. Pain with palpation. Mild weakness.
- Stage II: Tendon is elongated or partially torn. Flexible flat foot develops. Difficulty performing a single-leg heel rise.
- Stage III: Rigid flat foot. Tendon is severely degenerated. Subtalar joint arthritis begins.
- Stage IV: Ankle joint involvement with valgus tilt of the talus.
Stages I and II respond well to conservative care. Stage III and IV typically require surgical intervention.
The single-leg heel rise test: Stand on one foot and attempt to rise up on your toes. If you cannot complete 10 single-leg heel rises, or if the test is significantly weaker or more painful on one side, posterior tibial tendon dysfunction is likely — seek evaluation promptly.
Who Gets Posterior Tibial Tendonitis?
- Middle-aged and older women (most common demographic)
- Runners — particularly those with high training volumes or sudden load increases
- People who are overweight — increased load on the medial arch
- Patients with pre-existing flat feet or over-pronation
- Athletes in court sports with rapid direction changes
Treatment at Pittsburgh Physical Medicine
Physical Therapy — The Essential Intervention
Dr. Crockatt designs a progressive posterior tibialis strengthening program that addresses both the tendon itself and the broader kinetic chain — calf strength, hip abductor strength, and foot intrinsic muscle activation all contribute to arch support. Eccentric and isometric loading protocols are used based on the stage of tendon involvement.
Orthotic Therapy
A medial arch support or custom orthotic offloads the posterior tibial tendon and prevents progressive arch collapse during the rehabilitation period. This is an essential component of Stage II management.
Graston Technique
IASTM applied along the tendon course — from the medial calf to the midfoot insertion — addresses tendon adhesions and promotes tissue remodeling.
Shockwave Therapy
For established tendinopathy that is not responding to initial conservative management, ESWT provides a powerful stimulus for tendon healing.
Chiropractic Foot and Ankle Assessment
Restricted subtalar and talonavicular joint mobility alters the biomechanical demands on the posterior tibial tendon. Restoring normal joint motion reduces tendon load.
Suffering from Posterior Tibial Tendonitis?
Our team at Pittsburgh Physical Medicine treats this condition with chiropractic care, physical therapy, and soft tissue techniques — under one roof in East Liberty, Pittsburgh.
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