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Posterior Tibial Tendon Dysfunction (PTTD) Therapy

Take the first step towards pain-free living with our specialised treatments

What is Posterior Tibial Tendon Dysfunction (PTTD)?

Posterior Tibial Tendon Dysfunction (PTTD) is a condition that is characterised by the weakening or tearing of the posterior tibial tendon, which runs along the inside of the ankle and foot.

When this tendon becomes damaged or inflamed, it can lead to symptoms like pain, swelling, and a progressive flattening of the foot. PTTD is often referred to as adult-acquired flatfoot because it typically develops in adults and leads to the gradual loss of the arch.

Understanding the nature of PTTD, including its symptoms, causes, diagnosis, and treatment options, is essential for effective management. At UFIT Podiatry, a specialised approach is adopted to provide relief and promote recovery for individuals suffering from PTTD.

What is Posterior Tibial Tendon Dysfunction (PTTD)?

Posterior Tibial Tendon Dysfunction (PTTD) is a condition that affects the posterior tibial tendon, which plays a crucial role in supporting the arch of the foot and maintaining proper foot mechanics. When this tendon becomes damaged or inflamed, it can lead to pain, swelling, and a progressive flattening of the foot. Understanding the nature of PTTD, including its symptoms, causes, diagnosis, and treatment options, is essential for effective management. At UFIT Podiatry, a specialized approach is adopted to provide relief and promote recovery for individuals suffering from PTTD.

PTTD is a progressive condition characterized by the weakening or tearing of the posterior tibial tendon, which runs along the inside of the ankle and foot. This tendon is responsible for supporting the arch and stabilizing the foot during movement. When the tendon becomes dysfunctional, it can lead to a collapse of the arch, resulting in flatfoot deformity. PTTD is often referred to as adult-acquired flatfoot because it typically develops in adults and leads to the gradual loss of the arch.

Symptoms of Posterior Tibial Tendon Dysfunction (PTTD)

The symptoms of PTTD can vary depending on the stage of the condition but generally include:
1

Pain and Swelling

Pain along the inside of the ankle and foot, which may be accompanied by swelling. The pain often worsens with activity.

2

Flatfoot Deformity

A visible flattening of the arch, leading to an outward rolling of the ankle and foot.

3

Weakened Foot Function

Difficulty in standing on tiptoe or performing activities that involve pushing off with the affected foot.

4

Limited Mobility

Reduced range of motion in the foot and ankle, making walking or other activities painful and challenging.

5

Tenderness in the
Inner Ankle or Arch

Tenderness along the course of the posterior tibial tendon, from the inside of the ankle to the middle of the arch.

6

Knee & Back Pain

Feeling pain in any part of your and/or have back pain after a long day of activity

Podiatry OTTD inside ankle
Arch Pain

Causes of Posterior Tibial Tendon Dysfunction (PTTD)

Understanding the causes of Posterior Tibial Tendon Dysfunction (PTTD) is crucial for effective management and prevention.
Overuse or Repetitive Strain Activities that place repetitive stress on the posterior tibial tendon, such as running, jumping, or sports, can lead to inflammation and microscopic tears.
Age-Related Degeneration As we age, tendons naturally lose some of their elasticity and strength. This degenerative process can make the posterior tibial tendon more vulnerable to injury and dysfunction.
Obesity or Excess Weight Carrying excess body weight places increased stress on the posterior tibial tendon, accelerating tendon breakdown and contributing to inflammation and micro-tears.
Trauma or Injury Acute injuries to the ankle can damage the posterior tibial tendon. Even minor injuries can sometimes initiate the inflammatory process that leads to PTTD, especially if the tendon was already weakened.
Inflammatory Diseases Systemic inflammatory conditions like rheumatoid arthritis, psoriatic arthritis, or lupus can cause inflammation throughout the body, including the tendons.
Biomechanical Issues Pre-existing foot problems, such as flatfoot (pes planus) or abnormal foot mechanics, can place excessive strain on the posterior tibial tendon.

Stages of Posterior Tibial Tendon Dysfunction (PTTD)

Posterior Tibial Tendon Dysfunction (PTTD) is a progressive condition, meaning it tends to worsen over time if not addressed.
Understanding its stages helps in early diagnosis and appropriate intervention at podiatry clinics.

Stage 1: Early Inflammation & Pain

In this initial stage, the posterior tibial tendon is inflamed and painful, typically along the inside of the ankle and foot. There may be mild swelling, but the foot arch remains largely intact and flexible. Walking may be painful.

Stage 2: Tendon Damage & Arch Collapse

As the condition progresses, the posterior tibial tendon begins to lengthen and degenerate, losing its ability to support the arch effectively. Patients often experience increased pain, weakness, and difficulty with activities like walking or running. At this stage, you may not be able to stand on your toes on one leg.

Stage 3: Rigid Flatfoot Deformity

At this advanced stage, the foot deformity from Posterior Tibial Tendon Dysfunction becomes more significant and rigid. Arthritis may begin to develop in the joints of the hindfoot due to the chronic misalignment and increased stress. Pain symptoms are often more severe and constant, and walking can become significantly impaired.

Stage 4: Ankle Deformity & Arthritis

The most severe stage involves the progressive flatfoot deformity extending to affect the ankle joint. The ankle may start to tilt outwards (valgus deformity), leading to instability and further pain. Significant arthritis develops not only in the foot but also in the ankle joint itself, severely limiting motion and function.

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Our Approach to Posterior Tibial Tendon Dysfunction (PTTD) Physical Therapy

At UFIT Podiatry, a personalised and comprehensive approach is adopted to manage PTTD, focusing on relieving symptoms, promoting healing, and preventing recurrence. The management strategy includes:
podiatry-elliott-with-client-feet
Step 1. Thorough AssessmentA detailed initial assessment is conducted to understand the patient’s condition, lifestyle & any contributing factors. This involves a physical examination, gait analysis & a review of medical history.
Podiatry assessment inner ankle pointing
Step 2. Custom Management PlansBased on the assessment, a tailored management plan is developed for Posterior Tibial Tendon Dysfunction. This may include a combination of conservative measures and physical therapy.
Podiatry shockwave inner ankle
Step 3. Advanced TherapiesUFIT Podiatry offers advanced therapeutic options for PTTD such as Radial Shockwave and Focal Shockwave Therapy.
UFIT Podiatrist Consults Client while holding insoles
Step 6. Follow-Up CareRegular follow-up appointments are scheduled to monitor progress, adjust treatment plans as necessary, and ensure long-term recovery and management. UFIT Podiatry emphasises continuous care to help patients achieve and maintain foot health.
UFIT Podiatry 3D printing custom insoles
Step 4. Custom Made OrthoticsCustom orthotic devices are designed and fitted to provide optimal support, correct foot mechanics, and reduce strain on the arches. These orthotics are created based on precise measurements and tailored to the patient’s specific needs.
Podiatry orthotics
Step 5. Supportive Ankle Foot OrthoticsFor severe cases and post surgical PTTD foot orthotics provide the maximum external support and allow full functionality.

PTTD, though often painful and debilitating, can be effectively managed with a combination of appropriate treatments and preventive measures. By understanding the causes, symptoms, and available treatment options, individuals can take proactive steps towards relief and improved tendon health. At UFIT Podiatry, a patient-centered approach ensures that those suffering from PTTD receive the best possible care, tailored to their unique needs. Through comprehensive assessments, advanced therapies, and personalized treatment plans, UFIT Podiatry helps patients overcome the challenges of PTTD and achieve long-lasting comfort and mobility.

Our Approach to Posterior Tibial Tendon Dysfunction (PTTD) Physical Therapy

At UFIT Podiatry, a personalised and comprehensive approach is adopted to manage PTTD, focusing on relieving symptoms, promoting healing, and preventing recurrence. The management strategy includes:
podiatry-elliott-with-client-feet
Step 1. Thorough AssessmentA detailed initial assessment is conducted to understand the patient’s condition, lifestyle & any contributing factors. This involves a physical examination, gait analysis & a review of medical history.
Podiatry assessment inner ankle pointing
Step 2. Custom Management PlansBased on the assessment, a tailored management plan is developed for Posterior Tibial Tendon Dysfunction. This may include a combination of conservative measures and physical therapy.
Podiatry shockwave inner ankle
Step 3. Advanced TherapiesUFIT Podiatry offers advanced therapeutic options for PTTD such as Radial Shockwave and Focal Shockwave Therapy.
UFIT Podiatry 3D printing custom insoles
Step 4. Custom Made OrthoticsCustom orthotic devices are designed and fitted to provide optimal support, correct foot mechanics, and reduce strain on the arches. These orthotics are created based on precise measurements and tailored to the patient’s specific needs.
Podiatry orthotics
Step 5. Supportive Ankle Foot OrthoticsFor severe cases and post surgical PTTD foot orthotics provide the maximum external support and allow full functionality.
UFIT Podiatrist Consults Client while holding insoles
Step 6. Follow-Up CareRegular follow-up appointments are scheduled to monitor progress, adjust treatment plans as necessary, and ensure long-term recovery and management. UFIT Podiatry emphasises continuous care to help patients achieve and maintain foot health.

PTTD, though often painful and debilitating, can be effectively managed with a combination of appropriate treatments and preventive measures. By understanding the causes, symptoms, and available treatment options, individuals can take proactive steps towards relief and improved tendon health. At UFIT Podiatry, a patient-centered approach ensures that those suffering from PTTD receive the best possible care, tailored to their unique needs. Through comprehensive assessments, advanced therapies, and personalized treatment plans, UFIT Podiatry helps patients overcome the challenges of PTTD and achieve long-lasting comfort and mobility.

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SINGAPORE'S MOST ADVANCED TECHNOLOGY We're the only clinic in Singapore to offer advanced gait analysis and in-house 3D-printed insoles with a comprehensive report.
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ELITE LEVEL OF CARE FOR
ALL INDIVIDUALS
ELITE LEVEL OF CARE FOR
ALL INDIVIDUALS

We offer personalized, evidence-based lower limb care for athletes, active individuals, and parents seeking specialized treatment for their children.

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GET ACCESS TO A MULTIDISCIPLINARY TEAM OF PROFESSIONALS
GET ACCESS TO A MULTIDISCIPLINARY TEAM OF PROFESSIONALS

We go beyond addressing your injury or pain. Through our Circle of Care, you can access our team of experts with a vast range of specialised experience and knowledge.

What to expect on your first visit

1
FULL BODY ASSESSMENT
We recognise the interconnectedness of musculoskeletal health, so we assess your entire body, not just your feet. We also focus on vital health indicators impacting your lower limbs, like circulation, nerve function and alignment.
2
ADVANCED TECHNOLOGY

We use cutting-edge diagnostic tools to get real-time insights into your soft tissue, joints and structures to provide a fast and accurate diagnosis.

3
DETAILED REPORT

Post-assessment, you will receive clear and comprehensive reports detailing our findings. This will allow you to make informed decisions on your treatment plan.

4
TREATMENT PLAN

Together with you, we formulate a comprehensive and personalised treatment plan that suit your goals and preferences. 

Meet Our Podiatry Team

Lewis 1080 Bio

Lewis Nurney

Lewis is a highly experienced podiatrist with over 5 years of practice in Singapore, bringing his expertise to UFIT's comprehensive Circle of Care. As Head of Podiatry at UFIT Club Street, he specialises in sports podiatry, innovative orthotics for adults and children (including 3D-printed custom insoles, Paediatric AFOs and SMOs for pediatric flat feet), and minimally invasive procedures.

A first-class honours graduate from the University of Huddersfield (UK), Lewis holds dual certifications in Extracorporeal Shockwave Therapy (ESWT), Diagnostic Ultrasound and Running Gait analysis. Previously with East Coast Podiatry, he now provides patient-centred care at UFIT, specialising in non-surgical management of conditions like Foot Pain, Plantar Fasciitis and Achilles Tendinopathy in both children and adults, ultimately focused on alleviating discomfort and restoring optimal foot function.

Elliot 1080 Bio

Elliot Yeldham

Elliott is a dedicated podiatrist with over 7 years of healthcare experience, gained in both the UK's National Health Service (NHS) and private practice. He holds an Honours degree in Podiatry from Cardiff Metropolitan University (Wales), and brings a wealth of expertise to Singapore.

Specialising in Musculoskeletal (MSK) podiatry, Elliott's interests include sport podiatry and the management of gait abnormalities in both adults and children. He is also recognised for his skill and patient-focused approach in minimally invasive procedures for ingrown toenails and wart removal. Committed to a patient-centred and multidisciplinary model, Elliott actively stays informed of the latest healthcare advancements through clinical research and international conferences.

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Visit Our Podiatry Clinic

21 Club St, #01-01
Singapore 069410
+65 6225 5059
podiatry@ufit.com.sg
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Frequently Asked Questions about Posterior Tibial Tendon Dysfunction (PTTD)

Who is at risk for developing PTTD?

Individuals over the age of 40, especially women, are at higher risk. Other risk factors include obesity, pre-existing flat foot problems, participation in high-impact sports like running or basketball, and certain inflammatory conditions such as rheumatoid arthritis.

Can overuse or sports activities lead to PTTD?

Yes, absolutely. Overuse and repetitive stress from activities such as running, jumping, or sports involving sudden changes in direction are common contributors to PTTD. These activities can cause micro-tears and inflammation in the tendon, leading to its progressive weakening.

What happens if PTTD is left untreated? If left untreated, Posterior Tibial Tendon Dysfunction (PTTD) is a progressive condition where symptoms can worsen over time. It can lead to the collapse of the foot's arch, resulting in a painful, rigid flatfoot deformity. In its advanced stages, it can also cause significant arthritis in the foot and ankle, leading to severe pain and greatly limited mobility.
What types of physical therapy are effective for Posterior Tibial Tendon Dysfunction (PTTD)?

Physical therapy for PTTD typically focuses on strengthening the posterior tibial muscle and other supporting muscles, improving flexibility, and correcting gait abnormalities. This often includes specific stretching exercises, strengthening exercises for the foot and ankle, and balance training.

Can posterior tibial tendon dysfunction be corrected without surgery?

In many cases, particularly in the earlier stages, PTTD can be effectively managed and improved with non-surgical approaches. These conservative treatments include custom orthotics in Singapore, braces, physical therapy, activity modification, and anti-inflammatory medication. Surgery is generally considered for more advanced stages or when conservative methods have not provided sufficient relief.

Is PTTD related to arthritis? Yes, PTTD can be closely related to arthritis, especially in its later stages. As the foot's arch collapses due to PTTD, the abnormal alignment places increased stress and wear on the joints of the foot and ankle. Over time, this chronic stress can lead to the development of painful arthritis in these joints.
How long does it take to recover from PTTD? The recovery time for PTTD varies significantly based on the severity of the condition, the stage at which podiatry treatment begins, and the individual's adherence to the management plan. Mild cases might show improvement within a few weeks to months with conservative care, while more advanced cases requiring extensive therapy or even surgery can take several months for significant recovery.
Can PTTD recur after therapy? Yes, PTTD can recur after physical therapy, especially if the underlying causes are not consistently managed. Regular maintenance, including continued use of orthotics, appropriate footwear, and adherence to recommended exercises, is crucial to prevent recurrence and maintain foot health.