Posterior Tibial Tendon Dysfunction

Explanation of Diagnosis

Posterior tibial tendon dysfunction means the posterior tibial tendon (which helps support the arch and stabilizes the ankle and foot) is irritated, weakened, or partially torn. It often develops gradually with repeated stress, especially from overuse, sudden increases in walking or standing, or poor footwear and foot mechanics. Common symptoms include pain along the inside (inner) ankle/arch, swelling, and discomfort that worsens with standing or walking. Some people also notice their arch getting flatter over time and difficulty pushing off with the affected foot.

Specific Work Modifications

• Try to limit continuous standing; use short breaks often instead of long uninterrupted periods.
• Use a sit-stand option or a stable stool so you can alternate positions every 30 to 60 minutes.
• Wear supportive, well-cushioned shoes with a firm heel counter; avoid flimsy flats, slippers, and barefoot walking at work.
• If your job involves stairs or uneven floors, slow down and hold a handrail when possible.
• Consider a more supportive insole or brace if you already use one, and confirm fit with a clinician or fitter.
• Avoid lifting while doing prolonged “heel up” or pushing-off stances if that recreates your inner ankle pain.

Specific Activity Modifications

• Pause running, jumping, and high-impact aerobics until symptoms calm down.
• Reduce hills, speed walking, and stairs for now; choose flatter routes and slower pacing.
• In the gym, avoid deep squats, heavy calf raises, and exercises that pinch or sharply increase inner ankle pain.
• Choose lower-impact activities like cycling on a supportive seat, swimming, or using an elliptical at a comfortable resistance.
• Avoid barefoot walking and unstable surfaces (grass, sand, foam pads) that make your arch collapse.
• If hiking, keep steps shorter, use trekking poles for support, and stop at the first clear increase in pain or swelling.

Recommended Supplements

None

Recommended Nutrition and Hydration

Diet Recommendations

• Choose an overall anti-inflammatory pattern: vegetables, fruit, whole grains, legumes, fish, and olive oil.
• Aim for adequate protein at most meals (for example, lean meats, fish, eggs, dairy, beans, or tofu) to support tissue repair.
• Include vitamin C–rich foods (citrus, berries, peppers) and zinc-containing foods (meat, shellfish, beans, nuts) as part of balanced meals.
• If you have kidney disease, are pregnant, or take blood thinners, ask your clinician before using any supplement.

Hydration Tips

• Drink enough fluids so your urine is light yellow most of the day.
• Spread fluids through the day, especially if you stand a lot or are in warm environments.

Home Exercise Prescription

Do these exercises 4 to 5 days per week, and stop or scale back if you get sharp, worsening inner ankle pain.

1. Ankle range of motion: Sit or stand supported, gently move your ankle up and down as far as comfortable, 2 sets of 10 slow repetitions.
2. Arch doming (short foot): While keeping your toes relaxed, gently “lift” the arch without curling the toes, hold 5 seconds, 2 sets of 10 reps.
3. Ankle inversion isometrics: With your foot flat, gently press the inside of the foot inward against your other hand (no joint movement), hold 5 seconds, 2 sets of 10.
4. Calf stretch (straight knee): Face a wall, affected foot back, keep heel down, lean forward until you feel a stretch in the calf, hold 30 seconds, 3 repetitions.
5. Supported single-leg balance: Hold a counter or wall lightly, stand on the affected side for 20 to 30 seconds, 3 repetitions, focusing on keeping the arch from collapsing.
6. Heel raises only if tolerated: Hold a counter, rise up slowly and lower slowly, 2 sets of 6 to 8 reps, only if inner ankle pain stays mild and doesn’t increase afterward.

Helpful Books

• "Explain Pain" written by David Butler and Lorimer Moseley
• "Move Your DNA" written by Katy Bowman
• "Harvard Medical School Family Health Guide" written by Harvard Medical School