Evidence checked as of October 2026. Written by The Wellness Team.
What is posterior tibial tendon dysfunction?
The posterior tibial tendon runs down the inside of the lower leg, behind the inner ankle bone, and supports the arch of the foot. When it becomes inflamed, degenerates or tears, the arch can gradually flatten. The condition is called posterior tibial tendon dysfunction, or PTTD. It has also been called adult acquired flatfoot, and more recently progressive collapsing foot deformity.
It is most often seen in adults in midlife and beyond, and is linked with being overweight, high blood pressure, diabetes and previous foot injury. It is not a childhood flat foot that was always there.
What are the symptoms?
Early on there is pain and swelling along the inner ankle and arch, worse after walking or standing. Over time the arch may lower, the heel drifts outwards and the pain can move to the outer ankle. A classic test is the single heel rise: if you cannot rise onto the toes of one foot, or the heel does not turn inwards as you rise, the tendon may not be working properly. A clinician checks this and looks at the foot from behind.
How is it diagnosed?
Examination comes first, including how you stand and walk. Weight-bearing X-rays show the arch and the alignment of the hindfoot. Ultrasound shows swelling or a tear in the tendon. MRI is used to stage the problem and plan surgery. Early diagnosis matters, because the condition is much easier to manage before the foot becomes stiff and fixed.
What helps in the early stages?
A scoping review of early PTTD, now called tibialis posterior tendinopathy, shows that research is still developing. Existing evidence favours non-surgical care first. A systematic review and meta-analysis found that orthoses combined with stretching and strengthening exercises gave better outcomes than orthoses plus stretching alone. The studies were few and used different regimens, so firm conclusions are limited.
In practice, a supportive shoe, an in-shoe orthotic and a graded strengthening programme for the calf, the posterior tibial muscle and the foot are the core. Weight loss helps where it is relevant. For more advanced stages, the American College of Foot and Ankle Surgeons consensus supports an ankle-foot orthosis for stage 2 and 3 disease in some people, with one study reporting that 90% of patients using a custom device had less pain and better function at two years.
When is surgery considered?
Surgery is considered when proper non-surgical care has failed or the foot is deformed. Procedures range from tendon debridement and transfer of a neighbouring tendon to bone realignment and, in advanced disease, fusion. A foot and ankle surgeon decides this after imaging.
Where does PRP fit?
There is no good evidence that PRP corrects PTTD. Reviews of PRP for lower limb tendons are mixed, and a 2026 meta-analysis found no significant benefit over placebo in Achilles tendinopathy. PRP does not rebuild an arch or reverse a deformity. It may be reasonable to discuss for a person with early tendon pain and a preserved arch who has completed rehabilitation, with realistic expectations, and as an addition to an orthotic and exercise plan rather than a substitute.
How can The London PRP Clinic by The Wellness help?
We assess whether the tendon is the problem, how far the foot has changed and whether you need a surgical opinion. PRP is offered at £450 a session where it is a reasonable option, with the limits of the evidence explained first.
Discuss your foot or ankle with the clinic: https://www.thelondonprpclinic.com/contact-best-prp-clinic-london
Review current services: https://www.thelondonprpclinic.com/services
When should you seek urgent help?
See a doctor promptly if you cannot walk on the foot, the arch has collapsed suddenly after an injury, or the leg is swollen, hot and red with fever. Calf pain and swelling with breathlessness or chest pain need emergency care.
Evidence and limits
Non-operative and operative management of PTTD, systematic review and meta-analysis. https://jassm.org/non-operative-and-operative-management-of-posterior-tibialis-tendon-dysfunction-a-systematic-review-and-meta-analysis/
Tibialis posterior tendinopathy, scoping review. https://pmc.ncbi.nlm.nih.gov/articles/PMC9781788/
ACFAS clinical consensus statement on adult acquired flatfoot. https://www.acfas.org/ACFAS/media/ACFAS_Media/Adult-Acquired-Flatfoot-Deformity-CSS.pdf
Posterior tibial tendon dysfunction, StatPearls overview of causes and risk factors. https://www.ncbi.nlm.nih.gov/books/NBK542160/
This is general information, not personal medical advice or a promise of results.