Posterior Tibial Tendon Dysfunction (PTTD) Treatment

How We Assess and Treat PTTD

What to Expect at Your Assessment

We start with a thorough assessment before recommending any treatment. This includes gait analysis, a biomechanical evaluation, joint function testing, and the single heel raise test as a clinical tool.

If clinically indicated, we use ultrasound imaging to assess the integrity of the posterior tibial tendon. This helps us determine how much damage the tendon has sustained and accurately stage the condition – which directly influences the treatment plan.

Dr Richard Chasen holds dual qualifications in podiatry and prosthetics & orthotics. This means he assesses both the clinical condition and the orthotic solution in a single appointment. You won’t need to be referred elsewhere for device prescription or fitting.

Non-Surgical Treatment Options

Custom foot orthotics are the front-line treatment for Stage I and Stage II PTTD. Orthotics support the arch, offload the tendon, and slow or halt progression. We manufacture custom orthotics on-site in our dedicated lab – ready in 48 hours, with same-day adjustments possible because the lab is here. This is particularly important for PTTD, where getting the right device fit early makes a real difference.

Ankle foot orthoses (AFOs) and the Richie Brace are used for more significant Stage II or early Stage III cases where greater ankle-level support is needed. The Richie Brace is a functional ankle brace specifically designed for PTTD management. We prescribe and fit AFOs as part of our service range – Dr Chasen’s prosthetics & orthotics qualification is directly relevant to the design and fitting of these devices.

Activity modification and targeted exercises help reduce load on the tendon while strengthening the calf and posterior tibial muscle. Exercises such as eccentric heel raises are commonly prescribed and are most effective in early stages. Your exercise programme should be guided by your podiatrist to avoid aggravating the tendon.

Footwear guidance is an important part of managing PTTD. Supportive, motion-control footwear reduces the strain on the tendon and complements your orthotic treatment.

Immobilisation may be used in acute or severely painful cases. A short period in a moon boot can rest the tendon and bring inflammation under control before longer-term treatment begins.

When Is Surgery Needed?

Most Stage I and Stage II cases are managed successfully without surgery. That’s the majority of patients we see with this condition.

Stage III and Stage IV are more likely to require surgical referral. We work in conjunction with orthopaedic and podiatric surgeons when surgery is the appropriate next step.

The best way to reduce the likelihood of surgery is early treatment. If you’re noticing symptoms, getting assessed now gives you the widest range of options.

Why Choose The Lower Limb Clinic for PTTD Treatment

Dual qualifications directly relevant to PTTD. Dr Chasen holds a Bachelor of Prosthetics & Orthotics in addition to his podiatry qualifications – a combination virtually unique in Australia. PTTD treatment centres on orthotic and bracing decisions. He understands device design and fabrication at a level beyond standard podiatry training.

On-site orthotic lab with 48-hour turnaround. Custom orthotics are the front-line treatment for PTTD. Most clinics outsource manufacturing and wait two to three weeks. We make them on-site in 48 hours. Same-day adjustments are possible because the lab is here.

AFOs and Richie Bracing on-site. For more advanced cases requiring ankle-level support, we prescribe and fit ankle foot orthoses including the Richie Brace. Dr Chasen’s prosthetics & orthotics qualification means you’re assessed, prescribed and fitted by someone who understands these devices from design through to function.

Diagnosis before treatment. We assess your condition and review imaging before recommending any treatment. You won’t receive a one-size-fits-all prescription.

27+ years and a professional referral network. Established in 1997. We work with rheumatologists, orthopaedic surgeons, and podiatric surgeons when onward referral is needed. Rated 4.9 stars from 52 Google reviews.

Frequently Asked Questions About PTTD

What is the difference between PTTD and adult acquired flatfoot?

They describe the same condition at different points. PTTD is the name for the tendon problem itself. Adult acquired flatfoot is what develops as the tendon fails and the arch collapses. If you’re searching for flat foot treatment, there’s a good chance the underlying cause is undiagnosed PTTD.

How do I know if I have PTTD?

The key signs are pain and swelling along the inside of your ankle, arch flattening, and difficulty or pain when rising onto your toes on one foot. An assessment with a podiatrist is needed to confirm the diagnosis and identify the stage, which determines the right treatment approach.

Can PTTD be treated without surgery?

Yes – in most cases, particularly Stages I and II. Custom orthotics, ankle foot orthoses, targeted exercises, and activity modification are effective for the majority of patients. Surgery is generally considered when conservative treatment has not achieved adequate improvement or when the deformity is rigid.

How long does PTTD take to heal?

This depends on the stage and how consistently you follow the treatment plan. Stage I, with regular orthotic use and load management, may show improvement within a few months. Stage II can take longer. In many cases, PTTD is managed rather than fully “cured” – the goal is to stop progression and reduce symptoms to a level where you can return to normal activity.

Can orthotics fix posterior tibial tendon dysfunction?

Custom orthotics are the front-line treatment for early-to-mid stage PTTD. They support the arch, reduce load on the tendon, and in many cases halt progression. Off-the-shelf insoles are not adequate for this condition – prescription orthotics matched to your biomechanics are needed. We make these on-site in 48 hours.

What exercises help PTTD?

Calf raises – particularly eccentric heel lowering – and posterior tibial strengthening exercises are commonly used. These are most effective in early stages and should be guided by your podiatrist to avoid aggravating the tendon. Exercises work alongside orthotics, not as a replacement for them.

Does PTTD get worse without treatment?

Yes. PTTD is a progressive condition. Left untreated, it moves from a flexible, correctable deformity to a rigid one, and eventually involves the ankle joint. Earlier treatment means more options and a better outcome.

Service Area

We treat patients with PTTD and adult acquired flatfoot from Elsternwick, Caulfield, St Kilda, Brighton, Armadale, Malvern, Elwood, and surrounding Melbourne suburbs. Our clinic is at 558 Glen Huntly Rd, Elsternwick – five minutes from Elsternwick Station.

Ready to Get Your PTTD Assessed?

PTTD responds well to treatment when it’s caught early – and most cases don’t need surgery. The sooner you’re assessed, the more options are available to you.

We offer gap-free assessments for eligible patients with appropriate private health cover. Custom orthotics are ready in 48 hours from our on-site lab. After-hours appointments are available.

If you have more questions or need to schedule an appointment, contact us at The Lower Limb Clinic in Melbourne. We’re here to help you find relief and get back to your daily activities.