Tibialis posterior tendon dysfunction is a problem with the tendon that runs behind the inner ankle bone and helps support the arch of the foot. When the tendon becomes painful and weak, the arch can gradually flatten, which is why it is a common cause of adult acquired flatfoot. In the early stages, a combination of foot orthoses and progressive strengthening exercise can reduce pain and improve function.
Also known as posterior tibial tendon dysfunction, PTTD, tibialis posterior tendinopathy, adult acquired flatfoot, progressive collapsing foot deformity, fallen arch
Symptoms
- Pain and sometimes swelling along the inner side of the ankle and arch
- The arch of the foot gradually flattening, often on one side
- Difficulty or pain standing on tiptoe on the affected leg
- Tiredness or aching in the foot and ankle after walking or standing
- In later stages, pain on the outer side of the ankle as the foot rolls further
Causes and risk factors
- Gradual wear and overload of the tendon, especially from middle age onwards
- Being female and over 40
- Higher body weight
- Existing flat feet
- Conditions such as high blood pressure, diabetes or inflammatory arthritis, and previous steroid injections near the tendon
What the evidence says helps
- In early-stage tendon dysfunction, a 12-week programme of foot orthoses and stretching reduced pain and improved function, and adding progressive resistance exercise gave greater improvement.3
- A systematic review found moderate effects for eccentric strengthening combined with orthoses and stretching, but highlighted that high-quality research is limited.2
- Foot orthoses with individual arch support may reduce pain in the early stages, and seem to work better when combined with exercise.4
- Not all trials agree: one found a moderate-intensity home exercise programme added little to orthosis wear alone, so exercise dose and supervision may matter.5
- In an observational study, most people with early-stage dysfunction did well with a structured orthosis and exercise programme, and only a small number went on to need surgery.6
Things you can try at home
- Wear supportive shoes with a firm heel counter and good arch support, and avoid walking barefoot for long periods
- Reduce long walks, hill walking or standing that flare symptoms, and build back up gradually
- Keep up any strengthening exercises you have been given, little and often
- If you are carrying extra weight, reducing it may lower the load on the tendon
- Seek assessment early, as early-stage problems are easier to manage
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- A sudden pop or tearing sensation at the inner ankle, followed by rapid flattening of the arch or being unable to stand on tiptoe: see your GP promptly or attend an urgent treatment centre
- If you have diabetes and your foot becomes hot, red and swollen, even without pain: seek same-day advice from your GP, diabetes foot team or NHS 111
- A hot, red, swollen ankle with fever or feeling unwell: contact NHS 111 or your GP urgently
- Numbness, tingling or burning in the foot: see your GP
- Severe pain after an injury with inability to bear weight: go to an urgent treatment centre or A&E
How Apollo can help
We assess your foot posture, tendon strength, single-leg heel raise, balance and walking pattern to understand how far the condition has progressed. Our team provides a progressive strengthening programme, load management advice and hands-on care where appropriate, and our podiatrist can advise on footwear. Because the evidence supports orthoses combined with exercise, we can assess you for 3D-printed custom orthotics, and we refer to an orthopaedic specialist if there are signs of a tear or a fixed deformity.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
Can a fallen arch from tibialis posterior dysfunction be reversed?
In the early stages, when the foot is still flexible, orthoses and strengthening exercise can reduce pain and improve function. Once the foot becomes stiff and fixed, non-surgical care aims to manage symptoms, and surgery may be discussed.
What exercises help tibialis posterior tendon dysfunction?
Progressive strengthening of the tibialis posterior muscle, such as resisted foot turning-in and heel raises, along with calf stretching, is commonly used. Trials suggest exercise works best alongside orthoses, and it should be tailored to your stage and symptoms.
Do I need orthotics for tibialis posterior tendon dysfunction?
Orthoses with arch support are a common part of early treatment and may reduce pain, particularly when combined with exercise. An assessment can help decide whether an off-the-shelf or custom device is most suitable.
References
- Kohls-Gatzoulis J, et al. (2009). The prevalence of symptomatic posterior tibialis tendon dysfunction in women over the age of 40 in England. Foot and Ankle Surgery. View source
- Ross MH, Smith MD, Mellor R, Vicenzino B (2018). Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines. BMJ Open Sport & Exercise Medicine. View source
- Kulig K, et al. (2009). Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise: a randomized controlled trial. Physical Therapy. View source
- Gómez-Jurado I, et al. (2020). Orthotic treatment for stage I and II posterior tibial tendon dysfunction (flat foot): a systematic review. Clinical Rehabilitation. View source
- Houck J, et al. (2015). Randomized controlled trial comparing orthosis augmented by either stretching or stretching and strengthening for stage II tibialis posterior tendon dysfunction. Foot & Ankle International. View source
- Alvarez RG, et al. (2006). Stage I and II posterior tibial tendon dysfunction treated by a structured nonoperative management protocol: an orthosis and exercise program. Foot & Ankle International. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
