Ankle & Foot
Posterior Tibial Tendon Dysfunction
Also called: Adult-acquired flatfoot
Failure of the tendon that holds up the inner arch, causing pain along the inner ankle and a progressively flattening foot. The critical fact: this is a progressive condition where early-stage treatment (loading, support) works well and late stages become structural — so 'my arch is falling' deserves prompt attention, not observation.
Common signs
- Pain and swelling along the inner ankle, behind the inner ankle bone
- The arch lowering; foot rolling inward
- 'Too many toes' visible from behind
- Unable to do a single-leg heel raise, or the heel doesn't swing inward when you try
Seek help now if
- Rapid arch collapse
- Numbness or vascular signs
- Inflammatory arthritis history with new tendon failure
Any of these: call 911 or get to an emergency room first. Everything else can wait.
What to do first
- Get staged now — the single-leg heel raise test is the key exam moment
- Early stages: arch support/orthotic plus a progressive tendon loading program is the proven combination
- Trim provocative load (long standing, uneven ground) while capacity is rebuilt
If it's become chronic
- Committed conservative care over months halts most early-stage progression
- Track the heel-raise count monthly — your objective tendon meter
- Progressing deformity despite quality care: specialist consult; earlier stages have better options
Natural healing options we use
- Progressive posterior tibialis loading program
- Orthotic/arch-support strategy
- Manual therapy and chiropractic care for foot-ankle mechanics
- PEMF and attended e-stim; tendon-support nutrition
About imaging
Weight-bearing X-rays assess alignment; MRI/ultrasound grade the tendon when staging or surgery is in question.
Daily self-care
- Daily heel-raise progressions with attention to heel position
- Wear the support during loading hours
- Report visible arch change promptly
More in Ankle & Foot
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Please read: this page is education, not a diagnosis. A proper examination is how a condition gets confirmed and a plan gets built. See our medical disclaimer.