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

Pain through the inside of the ankle is a common reason people attend our clinic, particularly after walking, running, or standing for long periods. While there are several possible causes of medial ankle pain, one condition that requires early attention due to its potential long-term consequences is posterior tibial tendon dysfunction, often referred to as PTTD.

The posterior tibial tendon plays a critical role in supporting the arch of the foot and stabilising the ankle during walking. When this tendon becomes overloaded or weakened, it can lead to progressive pain, loss of arch height, and changes in foot and ankle position. Without appropriate treatment, PTTD can worsen over time and, in more advanced cases, may require surgical management.

What Is Posterior Tibial Tendon Dysfunction (PTTD)?

Posterior tibial tendon dysfunction occurs when the posterior tibial tendon becomes inflamed, overstretched, or damaged. This tendon runs along the inside of the ankle and attaches into the midfoot, helping to maintain the arch and control foot motion during walking.

When the tendon is no longer able to tolerate load effectively, the foot begins to roll inwards, the arch may flatten, and the ankle can drift into a less stable position. Over time, this change in mechanics increases stress on surrounding joints and soft tissues, leading to pain, fatigue, and reduced function.

PTTD is one of the most common causes of adult-acquired flat foot and is best managed when identified early.

What Causes Pain on the Inside of the Ankle?

There are several factors that can contribute to posterior tibial tendon dysfunction:

Overuse

Repetitive loading from activities such as walking long distances, running, or standing for extended periods can overload the tendon. Sudden increases in training volume or intensity are a common trigger.

Age-Related Changes

PTTD is more common in older adults, as tendon tissue can lose strength and elasticity over time, making it more susceptible to injury.

Injury

A previous ankle injury or trauma can damage the tendon directly or alter foot mechanics, increasing strain on the posterior tibial tendon.

Foot Position and Function

People with flat feet, or feet that collapse significantly when standing or walking, place higher loads through the posterior tibial tendon. This increased demand can eventually lead to tendon failure if not addressed.

Early Warning Signs of Posterior Tibial Tendon Dysfunction

Recognising early symptoms is important, as treatment is far more effective in the early stages. Warning signs may include:

• Pain or swelling along the inside of the ankle

• Pain that worsens with walking or standing

• Fatigue or aching in the foot or ankle

• A gradual loss of arch height

• Difficulty standing on tip-toes on the affected side

• Shoes wearing unevenly due to altered foot position

If these symptoms are ignored, the condition may progress and become more difficult to manage.

The Stages of Posterior Tibial Tendon Dysfunction

PTTD is typically classified into four stages, each requiring different levels of intervention.

Stage 1: Tendon Inflammation

At this stage, the tendon is irritated but still functional. Pain and swelling are usually present, but the arch remains intact. Treatment often includes activity modification, targeted strengthening, and orthotics if required

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Stage 2: Tendon Weakening and Early Arch Collapse

The tendon begins to weaken and struggles to support the foot. Pain increases and walking may become difficult. The arch may start to flatten when standing. Treatment may involve rehabilitation exercises, orthotics, and in some cases bracing.

Stage 3: Progressive Flat Foot Deformity

The tendon can no longer support the arch, resulting in a fixed flat foot deformity. Pain may shift from the tendon itself to surrounding joints. Management typically includes orthotics, bracing, and more intensive rehabilitation.

Stage 4: Advanced PTTD and Ankle Arthritis

In advanced cases, deformity becomes severe and ankle arthritis may develop. Surgical intervention is often required at this stage.

How a Podiatrist Assesses Posterior Tibial Tendon Dysfunction

At My Family Podiatry, assessment goes beyond identifying where the pain is coming from. We aim to understand why the tendon is overloaded and how to reduce stress through the foot and ankle.

A typical assessment includes:

• Review of your medical history and activity levels

• Foot posture and arch assessment

• Heel and ankle alignment assessment

• Strength testing of the posterior tibial tendon

• Walking assessment in shoes and barefoot

• Footwear review

• Referral for imaging such as ultrasound or MRI if required

This thorough approach allows us to develop a treatment plan tailored to your specific presentation and goals.

Treatment Options for Posterior Tibial Tendon Dysfunction

Treatment depends on the stage of the condition and your activity demands.

Orthotics

Custom foot orthotics can help support the arch, improve heel alignment, and reduce load through the posterior tibial tendon. This can relieve pain and help prevent progression of the condition.

Richie Brace

For more advanced cases, a Richie Brace may be recommended. This custom ankle brace supports both the foot and ankle, reducing strain on the tendon during walking.

Exercise Rehabilitation

A structured strengthening program helps improve tendon capacity and support surrounding structures. Rehabilitation is an essential part of long-term management.

Surgery

Surgery is reserved for advanced cases where conservative treatment is no longer effective. Early intervention aims to avoid this outcome wherever possible.

Why Early Treatment Matters

PTTD is a progressive condition. Treatment in the early stages is typically far simpler and more effective than waiting until structural changes occur. Addressing the issue early can reduce pain, preserve foot function, and prevent long-term complications.

Frequently Asked Questions About PTTD

What does posterior tibial tendon pain feel like?

Pain is usually felt along the inside of the ankle and may worsen with walking or standing.

Can PTTD get better without treatment?

Mild cases may settle temporarily, but without addressing contributing factors, the condition often worsens over time.

Will orthotics help posterior tibial tendon dysfunction?

Orthotics are commonly used to reduce tendon load and improve foot position, particularly in the early and mid stages.

When is surgery required for PTTD?

Surgery is usually only considered in advanced cases where the tendon has failed and deformity or arthritis has developed.

When to Seek Help

If you have ongoing pain through the inside of your ankle, particularly if it is affecting your walking or daily activities, early assessment is important.

At My Family Podiatry, we regularly assess and treat posterior tibial tendon dysfunction for patients in Albany Creek and surrounding North Brisbane suburbs. Our goal is to help you return to comfortable movement while protecting the long-term health of your feet and ankles.

Click the button below or call 07 3088 6116 to book your appointment.

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