Flat Feet? It Could Be Posterior Tibial Dysfunction

Flat feet are often seen as minor discomfort rather than a symptom of a more serious condition. If you notice your arches weakening or pain in your ankles, posterior tibial tendon dysfunction (PTTD) could be the culprit. When the tendon weakens or becomes damaged, the arch collapses, leading to discomfort, difficulty walking, and even long-term structural issues.

What is Posterior Tibialis?

The posterior tibialis is a deep muscle inside your lower leg, passing behind the ankle and attaching to the foot’s arch. Its key functions include:

• It supports the foot’s arch and prevents it from collapsing
• Provides ankle stability while walking, running, and standing
• Prevents excessive inward rolling
• Absorbs impact to minimize stress on the knees, hips, and spine

What is Posterior Tibial Tendon Dysfunction (PTTD)?

PTTD affects the posterior tibialis tendon. It occurs when the posterior tibialis tendon becomes inflamed, overstretched, or torn. Over time, this leads to a progressive collapse of the foot’s structure, which can cause difficulty walking, chronic pain, and deformities. PTTD is one of the most common causes of adult-acquired flat feet. It usually targets one foot, but in some cases, it can develop in both.

Causes of Posterior Tibial Tendon Dysfunction (PTTD)

A sudden injury, such as a fall or a misstep, can tear or inflame the posterior tibial tendon. In some cases, repeated stress on the tendon—especially from high-impact activities—can cause it to weaken over time.

Other Risk Factors for PTTD

• Obesity
• Women over 40 of age
• Prolonged standing
• High blood pressure (hypertension)
• Having flat feet
• Diabetes
• Autoimmune conditions (such as rheumatoid arthritis)
• Long-term steroid use
• Wearing slip-ons, flip-flops, or soft-heel counter footwear
• Previous surgeries or injuries
• Repetitive stress or excessive force on the foot
• Pre-existing joint conditions (such as arthritis)

Stages of Posterior Tibial Dysfunction

PTTD is a progressive condition. If left untreated, it may lead to irreversible foot deformity and joint degeneration. Early intervention can prevent the condition from progressing to the later stages.

Stage 1: Early Warning Signs

The posterior tibial tendon is inflamed but still functional. Pain is present after walking or standing for long periods. Swelling may also appear, but you can still stand on your toes on one foot.

Stage 2: Arch Collapse Begins

The posterior tibial tendon weakens, and small tears may develop. The pain and swelling become more persistent. You may notice flattening of your arch, and standing on your toes with one foot becomes difficult or impossible.

Stage 3: Significant Foot Deformity

The arch completely collapses, causing a noticeable deformity in the foot’s shape. The foot and toes may start to turn outward while the ankle tilts inward.

Stage 4: Severe Deformity and Arthritis

At this stage, the entire foot and ankle are affected. Walking and daily activities become more complicated, and mobility is limited. At this point, conservative treatments are usually ineffective, and surgical intervention is often required to restore function and alleviate pain.

How Do You Know If You Have Flat Feet?

Some people are born with low arches, but when foot structure starts changing, it could be posterior tibial dysfunction. Not everyone with flat feet experiences pain or dysfunction. Still, if you’ve noticed changes in the shape of your arch or discomfort in your foot, it’s worth considering whether posterior tibial dysfunction is at play.

Some people are naturally born with flat feet. However, other factors can contribute to arch collapse, including:

• Tendon damage or weakness
• Pregnancy
• Rheumatoid arthritis or other inflammatory conditions
• Nerve issues
• Previous injuries

Wet Foot Test for Flat Feet

Wet the bottom of your feet using a shallow tray of water, a damp towel, or simply stepping out of the shower. Then, stand on a flat surface—a dry piece of cardboard, a bathroom tile, or a concrete sidewalk works best. Step away and examine your footprint.

What Your Footprint Reveals

• Normal Arch – If the middle section of your footprint has a curve along the inside of the foot, you have a normal arch.
• Flat Feet – If your entire foot leaves a full imprint with little to no curve along the inner side, your arch has collapsed.
• High Arch – If only your heel and the ball of your foot show, with little to no contact in between, you likely have high arches.

PTTD Treatments

The early stages of PTTD can still be addressed with enough rest, NSAIDs like ibuprofen or aspirin, and immobilization using a cast or boot for 6–8 weeks. After the cast is removed, arch supports, or heel wedges may help. A healthcare provider may also recommend custom ankle-foot orthosis for advanced cases.

If non-surgical treatments aren’t effective, your doctor may recommend surgery. Depending on the severity of your condition, multiple procedures may be required to correct progressive flat foot. Surgical options include:

• Arthrodesis
• Osteotomy
• Tendon transfer
• Tenosynovectomy
• Lateral column lengthening

How Can Chiropractic Treatment Help with PTTD?

Chiropractic care can help treat posterior tibial tendon dysfunction by relieving pain, improving foot mobility, and preventing future injuries. Here’s how it can help:

1. Manual Adjustments

Chiropractic adjustments realign the foot, ankle, knee, and hip, reducing stress on the posterior tibial tendon. Proper alignment can help improve mobility, reduce pain, and restore function.

1. Soft Tissue Therapy

Techniques like massage and myofascial release improve circulation and reduce inflammation in affected areas, promoting faster recovery.

1. Custom Orthotics

Chiropractors may recommend custom orthotic inserts to support the arch and reduce tendon strain. Proper foot alignment relieves pressure on the posterior tibialis tendon, improving stability.

1. Exercise & Rehabilitation

Strengthening and stretching exercises target the foot, knee, and hip muscles to improve stability and mobility. Rehab exercises help prevent re-injury and support long-term recovery.

1. Footwear & Lifestyle Guidance

Proper footwear is key. Chiropractors recommend shoes with good arch support and cushioning. Guidance on activity modifications helps prevent the worsening of PTTD symptoms.

If you’re dealing with PTTD, you don’t have to live with discomfort. At Chiro-Med, we provide a personalized treatment plan to guide you toward a smooth recovery. Let’s get you back on your feet—stronger, healthier, and pain-free! Contact us today for a consultation.

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