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Painful Flat Foot

A painful flat foot will often involve the posterior tibial tendon. The condition is called posterior tibial tendon dysfunction (PTTD) and it can be the result of a sudden change in activity levels, or it could be a gradual increase in discomfort due to increased demand on the tendon. The main purpose of this tendon is to help stabilise and support the medial arch of the foot.  The main cause of PTTD is overuse of the posterior tibial tendon if it is not strong enough to cope with the demand that is being placed on it.

The picture below shows the posterior tibial tendon illustrated in green.  Its main insertion point is being pointed out, however it has multiple insertions so the pain may spread around the arch of the foot.

Diagram showing Posterior Tibial Tendon

You might notice some swelling or pain around the inside of your ankle bone and into the arch of your foot. A reasonably reliable way of telling if this muscle is involved, is to try multiple heel raises on the unaffected leg – and then see if you can do the same on the affected leg without any discomfort.

Single leg heel raises exercise demo

Spending long periods standing, walking, or running – especially if there is a sudden increase in these activities is often the reason we see problems around this area.  Also if you are overweight, this will increase the stress through the posterior tibial tendon. Wearing footwear like trainers to support your foot is very important, as is the strength and flexibility of certain muscles.

Exercise videos

The videos below show exercises that may be useful in strengthening the the posterior tibial tendon to help it cope better with the demand that you are placing on it.

Don’t expect things to improve overnight though. It takes time for muscles and joints to adapt and get stronger

Please note: If you do not see any sign of improvement after 6-8 weeks of following the advice and exercises please get referred to your local Podiatry Department for more advice and support.

Patient Information

To find out more about Painful Flat Foot, including information and exercises, visit our webpage.