Posterior Tibial Tendon Dysfunction (PTTD): Symptoms, Causes, and Management Posterior tibial tendon dysfunction (PTTD) is a common foot and ankle condition that can lead to adult acquired flatfoot deformity (AAFD). The posterior tibial tendon is responsible for supporting the foot's arch and ankle during movement. PTTD occurs when this tendon weakens, along with the failure of ligaments around the foot and ankle, causing the medial arch to collapse and the foot to flatten. Symptoms of PTTD The most common symptoms of PTTD are: Pain on the inside of the foot and ankle Swelling Increased pain and weakness during physical activities Gradual flattening of the foot Ankle pain due to joint impingement caused by the foot deformity Causes of PTTD PTTD is commonly caused by overuse and repetitive strain, although acute injuries can also lead to inflammation and pain in the tendon. Risk factors for PTTD include: Pre-existing flat foot Hypermobility Age of 40 or older Obesity Diabetes Hypertension Engaging in high-impact sports Management of PTTD The management of PTTD depends on the severity of the condition. Mild cases of PTTD may be managed with non-surgical options, such as: The R.I.C.E method: Rest, Ice, Compression, and Elevation. Physical therapy Orthotics In more severe cases of PTTD, surgery may be necessary to repair the tendon and ligaments. If you are experiencing any of the symptoms of PTTD, please see a physician or a podiatrist for diagnosis and management.