Physiotherapy for Tibialis Posterior Dysfunction (PTTD)

What is tibialis posterior dysfunction?

Posterior tibial tendon dysfunction (PTTD), the most common cause of adult-acquired flatfoot, occurs when the tibialis posterior tendon becomes stretched, inflamed, or degenerated, losing its ability to support the medial longitudinal arch of the foot. Common in middle-aged individuals, runners, and individuals walking barefoot on hard floors across India, early stages present as medial ankle ache behind the inner ankle bone (medial malleolus). If untreated, the foot rolls inward, the arch collapses, and lateral impingement pain develops. Physiotherapy focuses on staged tendon rehabilitation (isometric to eccentric heel raises), custom arch-supporting orthotics, and gluteal strengthening to control lower limb alignment.

How physiotherapy helps

• Eccentric concentric single leg heel raises
• Tibialis posterior tendon isometric holds
• Short foot intrinsic foot arch strengthening
• Supportive footwear and orthotic guidance
• Lower limb alignment and balance retraining

Common signs

• Aching pain and tenderness along the inside of the ankle and foot, along the path of the posterior tibial tendon
• Swelling behind and below the medial malleolus (inner ankle bone)
• Progressive flattening of the foot arch with inward rolling of the heel (valgus deformity)
• Inability to perform a single-leg heel raise on the affected foot without pain or instability
• Lateral ankle pain in later stages due to compression between the fibula and calcaneus

Clinical rehabilitation framework

Evidence-informed clinical progression and starter exercise targets for tibialis posterior dysfunction.

Frequently asked questions

Related conditions & care

Plantar FasciitisPlantar fasciitis (also referred to as plantar fasciopathy or plantar heel pain) occurs when repetitive mechanical overload creates micro-tears and degenerative thickening at the origin of the plantar fascia on the medial calcaneus. In India, prolonged barefoot standing on hard marble, terrazzo, or tiled floors, unsupportive flat footwear, and sudden increases in walking distance commonly precipitate symptoms. Rather than complete rest, modern clinical guidelines recommend progressive mechanical loading (such as high-load strength training with toe elevation), calf and intrinsic foot muscle strengthening, manual tissue mobilisation, and appropriate temporary arch support or orthotics to facilitate long-term collagen remodeling.

Achilles TendinopathyAchilles tendinopathy is an overuse injury causing pain, swelling, and morning stiffness in the Achilles tendon, usually either in the mid-substance (2 to 6 cm above the heel) or at its insertion on the calcaneus. In recreational runners, badminton and cricket players, and individuals resuming exercise after sedentary periods in India, sudden increases in running volume or hill walking often overload tendon fibers. Modern tendon research shows that passive rest weakens the tendon further; instead, progressive mechanical loading through isometric holds, heavy slow resistance, and controlled eccentric heel drops stimulates collagen remodeling and tendon spring capacity.

Hallux Valgus (Bunion)Hallux valgus (commonly known as a bunion) is a progressive forefoot deformity where the big toe drifts towards the second toe, causing a painful prominence over the first metatarsophalangeal (MTP) joint. Narrow footwear, high heels, genetic foot shape, and flat arches (overpronation) accelerate the deformity and often trigger secondary transfer metatarsalgia under the ball of the foot. Conservative physiotherapy focuses on intrinsic foot strengthening (short foot exercises, toe yoga), abductor hallucis activation, first MTP joint mobilisations, and custom offloading pads to manage pain and keep you active without unnecessary surgery.

Ankle SprainAn ankle sprain happens when the ligaments are overstretched or torn, usually from rolling or twisting the ankle. It is one of the most common sports and everyday injuries. Physiotherapy helps reduce the early swelling and pain, then rebuilds strength and balance, because rushing back too soon is the main reason ankles sprain again.

Clinical guides & articles for tibialis posterior dysfunction

Evidence-informed articles, recovery timelines, and home care advice from our clinical library.