Posterior Tibial Tendon Dysfunction (PTTD) is a condition in which the posterior tibialis tendon—one of the primary stabilizers of the medial arch—becomes weakened or damaged. This tendon runs along the inside of the ankle and foot, supporting the arch and helping with foot inversion. When the tendon becomes overloaded or degenerates over time, it can lead to pain, swelling, and a progressive flattening of the arch, commonly referred to as adult-acquired flatfoot. PTTD often begins with discomfort along the inside of the ankle or foot and can worsen if not addressed early.
Management of PTTD typically involves a combination of conservative and, in more advanced cases, medical interventions. Physical therapy plays a central role in the early stages, focusing on strengthening the posterior tibialis muscle, improving foot and ankle alignment, and addressing compensatory movement patterns. Exercises such as resisted foot inversion, heel raises with arch control, and balance work can help restore function and reduce strain on the tendon. In more severe cases or when conservative care is insufficient, custom orthotics, bracing, or surgical intervention may be necessary. This video will cover the key exercises and treatment strategies used in physical therapy to support recovery and manage symptoms of PTTD.
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00:00 Introduction
00:24 What is Posterior Tibialis Tendon Dysfunction?
02:28 Exercise 1: Arch Doming
04:24 Exercise 2: Towel Curls
05:47 Exercise 3: Banded Inversion
07:54 Exercise 4: Inversion Biased Calf Raises
09:01 My Self-Guided Rehab Book