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  • Writer's pictureMy Family Podiatry

Pain Through The Inside Of The Ankle - Posterior Tibial Tendon Dysfunction

Updated: Mar 21, 2023

We commonly see patients presenting to the clinic with pain through the inside of the ankle, especially after walking, running or standing for long periods. While there are a number of possible causes for this ankle pain, one with potentially severe long term consequences is posterior tibial tendon dysfunction (PTTD).


PTTD is a condition that occurs when the posterior tibial tendon becomes damaged or weakened. This tendon runs along the inside of the ankle and works to support the arch of the foot and provide some stability to the ankle. Damage to this tendon can lead to pain, swelling and difficulty walking all the way through to collapse of the arch of the foot and arthritic changes requiring surgery.


PTTD can be caused by a variety of factors, including:

  • Overuse: Activities that involve repetitive stress on the foot such as running or walking long distances, can cause the tendon to become inflamed. Sudden increases in training load can also aggravate this tendon.

  • Age: PTTD is more common in older adults, as the tendon may weaken with age.

  • Injury: An injury to the ankle or foot can damage the tendon and lead to PTTD.

  • Foot Position and Function: People with flat feet or those with very mobile feet that flatten when standing may be more prone to developing issues with their posterior tibial tendon. This is due to the loads placed into the ankle by the flat foot.

There are four stages of PTTD, with each becoming progressively harder to treat:


Stage 1: Mild pain and inflammation in the tendon. This stage can be treated with rest, exercise therapy to strengthen the structures and orthotics if required to decrease the load through the ankle.

Stage 2: The tendon begins to weaken and is less able to tolerate the stresses being applied to it, leading to increased pain and difficulty walking. This stage can be treated with exercise rehabilitation, orthotics, and potentially a brace if required.

Stage 3: The tendon weakens further and is no long able to support the arch of the foot. This leads to the arch of the foot collapsing and flattening of the foot. This stage can be treated with orthotics and bracing and more aggressive physical therapy.

Stage 4: In the final stage, the tendon is severely damaged and the arch has collapsed significantly. The ankle position may be severely deformed as the tendon is no longer able to provide support. This stage is considered advanced and may require surgery to correct the deformity and relieve pain.


Several treatment options are available for PTTD, depending on the severity of the condition:

  • Orthotics: Custom orthotics can be made to support the arch of the foot, improve the heel and ankle position and reduce stress on the damaged tendon. These are worn in shoes and may help to reduce pain and prevent progression of the condition.

  • Richie Brace: The Richie Brace is a custom brace that is worn around the foot and ankle to support the arch and reduce stress on the tendon. This can be an effective treatment for more severe cases of PTTD.

  • Exercise Rehabilitation: An exercise program can be developed to strengthen the muscles and improve the range of motion in the foot and ankle. This can help to reduce pain, improve function and improve the integrity of the tendon.

  • Surgery: In severe cases of PTTD, surgery may be necessary to repair or replace the damaged tendon.

Early intervention is important in preventing the progression of PTTD. Treatment in the earlier stages involves far less rehabilitation to achieve a faster outcome and may prevent some of the complications seen with more extensive tendon damage.


If you have been struggling with pain through the inside of your ankle, do not delay seeking treatment. The team at My Family Podiatry are here to help get you back to the activities you enjoy without foot or ankle pain. Click the button below or call us on 07 3088 6116 to book an appointment.



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