Fixing Tibialis Posterior Tendon Dysfunction (PTTD)
Key insights: 60-second read
- PTTD is more than a foot problem – The tendon irritation is often a symptom of hidden restrictions at the ankle and hip causing the leg to rotate inward.
- Symptom-only treatments fail long-term – Orthotics and arch supports provide temporary relief but don't fix why your leg and arch are collapsing.
- The "top-down" approach – You can actively lift your arch by externally rotating your leg from the hip. If your arch lifts when you "screw your feet" into the ground, your leg's default position is the problem.
- Four-step protocol – 1) Symptom relief (tibialis posterior release), 2) Address ankle restrictions, 3) Address hip restrictions, 4) Reinforce the pattern with squats.
On this page
Main Ideas
While PTTD is often related to arch dysfunction, the arch dysfunction itself is often a symptom of hidden restrictions and compensations occurring at the ankle and hip. Effective treatment must therefore address the entire leg's kinetic chain.
1. Key Takeaways
1. PTTD is More Than a Foot Problem
The tibialis posterior tendon, which runs behind the inner ankle and supports the arch, becomes irritated due to excessive strain. This strain can be caused by a collapsing arch, but the arch collapse is often a consequence of the entire leg rotating inward (internal rotation).
2. The Pitfall of Symptomatic-Only Treatments
Orthotics and arch supports are symptomatic treatments. They help while you wear them but do not fix the underlying reason why your leg and arch are collapsing. The goal is to get your body to support the arch naturally.
3. The "Top-Down" Approach to Arch Support
You can actively lift your arch by externally rotating your entire leg from the hip. If your arch lifts when you screw your feet into the ground and rotate your knees out, it indicates that your leg's default position is the problem.
4. Identify the Hidden Restrictions
The body collapses the arch as a compensation to get around restrictions in mobility. The two primary culprits are:
- Ankle Joint Restrictions: A stiff ankle prevents the shin from moving forward properly, forcing the leg to collapse inward or the foot to turn out.
- Hip Restrictions: Tightness in the hip external rotators and flexors prevents the leg from staying in a stable, externally rotated position.
2. Step-by-Step Protocol
The video outlines a sequential four-part protocol to address both symptoms and causes:
Step 1: Symptom Relief - Tibialis Posterior Release
Goal: Release tension in the tibialis posterior muscle above the sore tendon.
How: Use a ball (e.g., lacrosse ball) on the inside of your shin bone.
- Sit with your heel off the edge of a chair or on the floor.
- Find the shin bone and move behind it, searching for tight, tender spots along the inner calf.
- Apply pressure and use techniques like static pressure, shearing, and tense-and-relax methods.
Step 2: Address Ankle Restrictions - Banded Ankle Stretch
Goal: Mobilize a stiff ankle joint to allow for proper forward movement.
How:
- Tie a resistance band to a sturdy object and loop it just above your ankle bones.
- Step forward to create tension, keeping the other foot in front.
- Lunge forward, bending your back knee while ensuring your knee stays aligned over your foot.
- Focus on driving your knee forward and slightly outward.
- Hold for 30 seconds to 2 minutes, or oscillate gently.
Step 3: Address Hip Restrictions - Two Key Stretches
Goal: Restore hip mobility to allow for stable, external leg rotation.
A. Hip External Rotation / Glute Stretch
- Sit tall and cross one ankle over the opposite knee (figure-four stretch).
- Keeping your back straight, hinge forward from the hips until you feel a stretch in your glutes.
- Use the "tense and relax" method: tense the tight glute muscles for 5-10 seconds, then relax and sink deeper.
B. Couch Stretch (Hip Flexor Stretch)
- Place the shin of your back leg against a wall or couch, with your front foot on the floor in a lunge position.
- Keep your back straight and squeeze the glute of the back leg.
- Use the same "tense and relax" method on the hip flexors.
Step 4: Reinforce the Pattern
Goal: Integrate the new mobility into a functional movement pattern.
How: Practice bodyweight squats with a focus on form.
- Keep your feet straight.
- As you squat down, consciously "screw your feet" into the ground to externally rotate your legs and lift your arches.
- Ensure your knees track in line with your feet and do not cave inward.
Conclusion
The key to long-term relief from PTTD is to stop treating just the sore tendon and start treating the dysfunctional leg mechanics causing it. By pairing symptomatic release with mobility work for the ankle and hip, you can create an environment where the tibialis posterior tendon is no longer overloaded and can heal effectively.
I genuinely hope this article offers a fresh perspective - or at least one useful takeaway. If you have a different issue, or simply want to learn more about how your body moves, head over to the Your Wellness Nerd YouTube channel. Subscribe if you feel inclined, and let me know in the comments what you'd like me to cover next.
– Grant
Frequently Asked Questions
What is Posterior Tibial Tendon Dysfunction (PTTD)?
PTTD is irritation of the tibialis posterior tendon, which runs behind the inner ankle and supports the arch. It's often caused by excessive strain from the leg rotating inward (internal rotation), collapsing the arch and overloading the tendon.
Can orthotics fix PTTD permanently?
Orthotics are symptomatic treatments - they help while you wear them but don't fix why your leg and arch are collapsing. Long-term relief requires addressing the underlying ankle and hip restrictions that cause the collapse.
What exercises help PTTD?
A four-step protocol: 1) Tibialis posterior release with a ball, 2) Banded ankle stretch for ankle mobility, 3) Hip external rotation stretch and couch stretch for hip restrictions, and 4) Bodyweight squats focusing on "screwing your feet" into the ground to reinforce proper leg rotation.
How do I know if my ankle or hip is causing my PTTD?
If your arch lifts when you externally rotate your leg from the hip (screw your feet into the ground), your leg's default position may be the problem. Common hidden restrictions include ankle stiffness (preventing forward movement) and hip tightness (limiting stable external rotation).
One profound insight from this post
"The tendon irritation is a symptom, not the root cause. By releasing the tibialis posterior, then addressing ankle and hip restrictions, you can stop the leg from collapsing inward and let the tendon heal."
Living With Persistent Pain?
If your pain has lasted longer than expected, feels disproportionate to injury, or hasn't responded to standard treatment, you may benefit from a broader approach. Learn more about our ankle pain physiotherapy services in Port Macquarie.
Want personalised guidance?
If you'd like help making sense of your aches, pains, or ongoing symptoms, you can book with Grant either in Port Macquarie or via an online telehealth consultation.
