Adult Acquired Flat Foot and Posterior Tibial Tendon Dysfunction 

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Posterior tibial tendon dysfunction (PTTD) may also be known as adult acquired flat foot, which refers to the progressive lowering of the foot arch and medial deviation of the ankle (pronation).

The posterior tibial tendon is responsible for holding the arch of the foot, when the muscle becomes overused it can begin to malfunction, resulting in overpronation. This can occur due to injury, poor foot biomechanics, ligamentous laxity and weight gain. Previously recognised as a common problem afflicting the elderly, PTTD has now become a more apparent issue amongst youths who are overweight, inactive, wear improper footwear such as slippers, or engage in high-impact sports.


Some risk factors include:

  • Pre-existing flat foot
  • Injury
  • Multiple pregnancies
  • Hypermobility
  • Being 40 years or older
  • Obesity
  • Diabetes
  • Hypertension
  • High impact sports



  • Pain presents on the inside of the foot and ankle
  • Swelling may or may not be present
  • Increased pain and weakness in the foot during physical activities such as walking and running
  • A gradual flattening of the affected foot
  • Pain in the ankle due to joint impingement from the progressive collapsing foot deformity
  • Tingling and numbness due to nerve irritation on the medial aspect of the foot as the foot collapses


How is Posterior Tibial Tendon Dysfunction (PTTD) Diagnosed?

Your podiatrist would check your walking pattern, foot range of motion and strength to determine the severity and stage of the deformity. They may also use imaging tools such as diagnostic ultrasound to confirm your diagnosis.


How is it treated?

Foot Orthotic

Foot orthotics can be used to offload the injury and prevent flat foot deformity from worsening. Orthotics can also reduce pressure placed upon the tibialis posterior tendon. Orthotics can be custom-made to fit any shoe, supporting you through every occasion. 


While home remedies such as compression with an elastic wrap or bandage can help reduce swelling. This is not a long term solution. Compression alone is unlikely to resolve the underlying condition, It should only be used as a temporary measure to relief symptoms, before podiatric management is sought. A podiatrist can include a range of non-invasive options using advanced modalities like Low Level Laser and shockwave therapy to stimulate healing and reduce pain.

If you are having issues as outlined above, contact us today to get your assessment and fimd out more about your foot health. 

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