Posterior Tibial Tendon Dysfunction Michigan | Flatfoot Specialist

Quick answer: Posterior Tibial Tendon Dysfunction Michigan is a common foot/ankle topic that affects many patients. Effective treatment starts with a targeted diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Township practices. Call (810) 206-1402.

Related Conditions

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Posterior Tibial Tendon Dysfunction Michigan

Posterior tibial tendon dysfunction (PTTD) is the most common cause of adult-acquired flatfoot deformity. It occurs when the posterior tibial tendon — the primary dynamic support of the longitudinal arch — degenerates, stretches, and ultimately fails. Left untreated, PTTD progresses from tendon pain to collapsed arch to rigid, arthritic flatfoot. Dr. Tom Biernacki DPM at Balance Foot & Ankle provides comprehensive PTTD care in Michigan at our Howell, Brighton, and Bloomfield Hills locations.

Stages of PTTD

• Stage I: Tendon inflammation (tenosynovitis) with preserved arch height and flexible flatfoot. Single-leg heel rise is painful but possible.
• Stage II: Tendon elongation and partial tear; flexible flatfoot deformity (collapsing arch). Single-leg heel rise is weak or impossible (“too many toes” sign).
• Stage III: Fixed (rigid) flatfoot deformity with hindfoot valgus. Subtalar joint arthritis.
• Stage IV: Fixed flatfoot with deltoid ligament insufficiency and valgus ankle tilt. Ankle arthritis.

Symptoms

• Pain and swelling along the inner ankle and foot (medial longitudinal arch)
• Gradual flattening of the arch
• “Too many toes” sign — extra toes visible from behind due to forefoot abduction
• Difficulty rising on the toes of one foot
• Hindfoot valgus (heel tilts outward)
• Lateral foot pain in advanced stages from fibular impingement

Diagnosis

Dr. Biernacki performs a complete clinical examination including single-leg heel rise test, gait analysis, hindfoot alignment assessment, and arch height measurement. Weight-bearing X-rays quantify talo-first metatarsal angle, calcaneal pitch, and hindfoot alignment. MRI evaluates tendon degeneration, partial tears, and spring ligament integrity. In Stage III–IV, CT assesses subtalar and ankle arthritis severity for surgical planning.

PTTD Treatment

Stage I: Immobilization in a CAM boot for 4–6 weeks to quiet tenosynovitis. After pain subsides, a custom-molded UCBL (University of California Biomechanics Laboratory) orthotic or rigid ankle foot orthosis (AFO) supports the arch long-term. Physical therapy strengthens the posterior tibial tendon and Achilles tendon complex.

Stage II: Aggressive bracing with an Arizona AFO or similar custom molded brace plus aggressive physical therapy. Surgical reconstruction is offered for young, active patients or those failing 3–6 months of conservative care. Dr. Biernacki performs medial displacement calcaneal osteotomy, flexor digitorum longus (FDL) tendon transfer, and spring ligament repair — the gold standard flatfoot reconstruction procedure for Stage IIB deformity.

Stages III–IV: Surgical arthrodesis (fusion) of the subtalar, talonavicular, and/or calcaneocuboid joints (triple arthrodesis) restores a plantigrade, pain-free foot. Ankle arthritis in Stage IV may require simultaneous ankle fusion or ankle replacement.

Frequently Asked Questions

Schedule your PTTD evaluation at Balance Foot & Ankle in Howell, Brighton, or Bloomfield Hills, Michigan.

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If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.

What is Foot pain?

Foot pain is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.

Symptoms and warning signs

Common signs of foot pain include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.

Conservative treatment options

Most cases of foot pain respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.

When is surgery considered?

Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.

Recovery timeline and prevention

Recovery from foot pain varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your Achilles tendon conditions, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.

Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist if: foot or ankle pain has lasted more than 2–4 weeks without improvement, you’re changing your gait to avoid pain, you have an open wound or sore that isn’t healing, you notice nail discoloration or thickening, you have diabetes and any foot concern, or pain is severe enough to wake you at night. Most foot conditions are easier and cheaper to treat early — what starts as a minor issue can become a surgical problem with months of delay.

What is the difference between a podiatrist and an orthopedic surgeon?

Podiatrists (DPM — Doctor of Podiatric Medicine) specialize exclusively in the foot, ankle, and lower leg. Orthopedic surgeons (MD/DO) have broader musculoskeletal training but variable foot/ankle subspecialization. For foot and ankle-specific problems, a podiatrist often has more focused training and experience. For injuries involving the leg above the ankle, complex pediatric cases, or multi-level reconstruction, orthopedic consultation may be appropriate. We frequently co-manage patients with orthopedic colleagues.

How do I know if my foot pain is serious?

Signs that warrant same-day or next-day evaluation: severe pain that appeared suddenly without clear cause, swelling, redness, and warmth that appeared suddenly (possible gout, infection, or Charcot fracture), an open wound that looks infected (redness spreading, pus, warmth), inability to bear weight, or any foot problem in a diabetic patient. Pain that’s been present for weeks and is stable is important but not an emergency — schedule within 1–2 weeks.

Can foot problems cause back and knee pain?

Yes — this is a kinetic chain effect. Abnormal foot mechanics (overpronation, supination, leg length discrepancy) cause compensatory changes in knee, hip, and lumbar alignment. Roughly 30% of patients presenting to our clinic with knee pain have a treatable foot-level biomechanical cause. Correcting foot mechanics with orthotics or appropriate footwear often provides significant knee and back relief. If you have chronic knee or back pain and haven’t had your foot mechanics evaluated, it’s worth a consult.

Are orthotics worth it?

For the right conditions, yes — custom orthotics are among the most cost-effective interventions in podiatry. They’re most effective for: plantar fasciitis, flat feet with secondary knee/back pain, leg length discrepancy, metatarsalgia, posterior tibial tendon dysfunction, and diabetic foot pressure management. Quality OTC orthotics ($35–60) resolve symptoms for 60% of patients with mild-to-moderate conditions. Custom orthotics are appropriate when OTC options have failed or when the biomechanical problem is complex. We cast custom orthotics in-office.

How do I choose the right running shoes?

Start with your foot type (flat, neutral, high arch) and running pattern (overpronator, neutral, supinator). Flat feet and overpronators do best in stability or motion-control shoes. Neutral feet do well in neutral-cushioned shoes. High arches need maximum cushioning with flexible soles. Always buy running shoes at the end of the day (foot swelling peaks then), get properly fitted by a specialist, and replace every 300–500 miles. If you’ve been injured repeatedly, a gait analysis can identify the mechanical flaw driving your injury pattern.

What is the difference between a sprain and a fracture?

A sprain is a ligament injury (the tissue connecting bones); a fracture is a break in the bone itself. Both can occur with the same trauma (ankle roll, fall). The old test — ‘if you can walk, it’s not broken’ — is wrong; many fractures are initially weight-bearable. Key differences: a fracture typically produces localized bone tenderness along the bone itself, while a sprain is tender over the ligament. X-ray is the standard to differentiate. High-grade sprains without proper treatment can be as disabling as fractures.

How do I prevent foot and ankle injuries?

The four most impactful prevention strategies: (1) Supportive, appropriately fitted footwear for your foot type and activity. (2) Gradual activity progression — the 10% rule (never increase weekly mileage or intensity by more than 10%). (3) Regular calf and ankle mobility work. (4) Strengthening the posterior tibial tendon, peroneals, and intrinsic foot muscles. Most overuse injuries are preventable; most acute injuries are not — but ankle sprain recurrence (60–70% without rehab) is prevented by balance and proprioception training.

Related Care at Balance Foot & Ankle

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