What is Stage 2 posterior tibial tendon dysfunction?

Stage 2 PTTD involves a flexible flat foot deformity — the arch and hindfoot deformity can be manually corrected. The posterior tibial tendon is partially torn or severely degenerated. This is the stage at which surgical intervention most effectively prevents long-term disability. Balance Foot & Ankle evaluates Stage 2 PTTD at (810) 206-1402.

How is Stage 2 PTTD treated non-surgically?

Conservative treatment includes a custom molded AFO or UCBL orthosis to support the arch and hindfoot, custom foot orthotics, physical therapy to strengthen the tendon, anti-inflammatory measures, and activity modification. Success rates for Stage 2 non-surgical care are approximately 70%. Balance Foot & Ankle at 4330 E Grand River, Howell and 43494 Woodward Ave #208, Bloomfield Hills provides comprehensive Stage 2 care.

What surgery is performed for Stage 2 PTTD?

Stage 2 PTTD surgery typically involves medializing calcaneal osteotomy (shifting the heel inward), lateral column lengthening, flexor digitorum longus tendon transfer to augment the failed posterior tibial tendon, and spring ligament repair. Balance Foot & Ankle's podiatric surgeons plan individualized reconstructions based on deformity components.

How long does it take to recover from Stage 2 PTTD treatment?

Non-surgical Stage 2 treatment produces improvement over 3–6 months with consistent orthotic use and therapy. Surgical recovery involves 8–12 weeks non-weight-bearing followed by 6–12 months of progressive rehabilitation. Balance Foot & Ankle monitors recovery milestones throughout treatment.

Is Stage 2 PTTD the best stage to treat for long-term outcomes?

Yes — Stage 2 offers the best balance between deformity flexibility (allowing correction without fusion) and tendon salvageability. Early intervention at Stage 2 prevents progression to the more disabling Stages 3 and 4. Contact Balance Foot & Ankle at (810) 206-1402 promptly if you have flexible flat foot with inner ankle pain.

When should I see a podiatrist?

For persistent foot/ankle pain, difficulty walking, numbness, non-healing wounds, skin changes, or deformities. Dr. Biernacki offers same-day appointments. Call 810-206-1402.

Does Dr. Biernacki accept insurance?

Balance Foot & Ankle accepts most major plans including BCBS, Aetna, United, Cigna & Medicare. Call 810-206-1402 to verify coverage. Affordable self-pay options available.

What to expect at your first podiatry visit?

Comprehensive evaluation including history, exam, biomechanical assessment, and in-office X-rays. Same-day diagnosis and treatment when possible. Most visits take 30-45 minutes.

What is stage 2 posterior tibial tendonitis?

Stage 2 is characterized by a flexible flatfoot deformity where the arch has collapsed but can still be manually corrected. The posterior tibial tendon is elongated or partially torn. This is the most common stage at which patients seek treatment.

Can stage 2 PTTD be treated with orthotics?

Yes, stage 2 PTTD often responds well to aggressive conservative treatment including custom orthotics with medial arch support, ankle braces or AFOs, physical therapy focused on strengthening the posterior tibial tendon, and activity modification.

How do I know if my flatfoot is getting worse?

Signs of progression include increasing pain along the inner ankle, the arch appearing flatter over time, difficulty performing a single-leg heel rise, the foot turning outward more, and shoes wearing unevenly. Regular podiatric monitoring helps track changes.

✅ Medically reviewed by Dr. Thomas Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026

STAGE 2 Inside of the Ankle Pain [ Posterior Tibial Tendonitis ]

STAGE 2 Inside of the Ankle Pain [ Posterior Tibial Tendonitis ] 🦶Do you have Posterior Tibial Tendonitis? AKA Inside of the Ankle Pain or Pain on Inside of the Foot? We go over the 4 stages of posterior tibial tendonitis pain! These are The BEST & Most PROVEN Treatment Options! Full Video: https://youtu.be/X1mtD7XUIsc 🦶 Related Videos: Flat Foot & Overpronation https://youtu.be/O_T6_xHTph0 Ankle strengthening full video: https://youtu.be/ZI0sANYDF6M Peroneal Tendonitis Treatment: https://youtu.be/bre6SmVm108 Posterior tibial tendonitis treatment: https://youtu.be/bkiRUlAfnZo Achilles tendonitis treatment: https://youtu.be/Y1sMEi7LNuA Anterior Tibial Tendonitis Treatment: https://youtu.be/55TGq-O8W_4 Best Arthritis Treatments: https://youtu.be/5M7ngir46yQ Best anti inflammatory diet for arthritis and joint pain: https://youtu.be/gCjN1Rya6es Best Supplements for joint pain and arthritis: https://youtu.be/8CVHgrf-FLQ Achilles Tendonitis pain! https://youtu.be/Z8DY5UAnXDk Walking Boot Tips: https://youtu.be/x2DcN9ZcZLo Numbness, Burning, or Tingling Foot Pain: https://youtu.be/Pdp9HLH9Gsg Heel Nerve Pain: https://youtu.be/1ZqubXExmc4 Plantar Fasciitis: https://youtu.be/2aXlnFVmIY8 Heel Spur: https://youtu.be/2rrt4xkeBiQ Best Ankle Brace? https://youtu.be/_01wslhkAx8 Best Orthotics For Flat Feet? https://youtu.be/9eY6kbccslQ Best Running Shoes for Flat Feet & Heel Pain 2022 [Top 5 Men & Women] 👉 Shoes 👈 Best Shoes:

Podiatrist Recommended Shoes 2026: The Complete Clinical Guide

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Podiatrist Recommended Orthotics

Best Products: https://www.michiganfootdoctors.com/recommended-foot-doctor-products/// 📢Come See Us in Detroit, Michigan, Berkley Michigan; Bloomfield Hills, Michigan, Lansing Michigan; and Grand Blanc Michigan📢 If you are in Michigan, consider seeing us at our clinic: https://www.michiganfootdoctors.com/. https://g.page/r/CaxJ9b-O6o27EAE DISCLAIMER: Dr. Tomasz Biernacki received his Doctor of Podiatric Medicine degree from Kent State College of Podiatric Medicine in 2013; he completed his Surgical Reconstructive Foot Surgery & Podiatric Medicine Residency in 2017; he completed 2x traveling Fellowships in Diabetic Surgery, Skin Grafting & Nerve Surgery. He is double board certified in Podiatric Medicine and Foot & Ankle Surgery. Dr. Biernacki is a licensed podiatrist & surgeon in Michigan. This video should not be used to self-diagnose and is not a substitute for a medical exam, cure, treatment, diagnosis, prescription, or recommendation. It does not create a doctor-patient relationship between Dr. Biernacki and you. It would be best to not change your health regimen or diet before consulting a physician and obtaining a medical exam & diagnosis. Always seek the advice of a physician or other qualified health provider with any questions regarding a medical condition.

At Balance Foot & Ankle, every Michigan patient receives expert podiatric care delivered with genuine attention to their individual needs and goals. Our podiatrists take time to explain diagnoses clearly, discuss all treatment options honestly, and follow up to ensure treatments are working effectively. We serve patients from Livingston and Oakland counties and the broader Southeast Michigan region from our Howell office at 4330 E Grand River and our Bloomfield Hills office at 43494 Woodward Ave #208. New patients are always welcome — call (810) 206-1402 to schedule today.

Michigan patients can count on Balance Foot & Ankle for the full range of podiatric services delivered with clinical excellence and genuine patient care. Whether your concern is a common foot condition that has been bothering you for years or an acute injury that needs prompt attention, our team in Howell and Bloomfield Hills is ready to help. We offer in-office diagnostics, evidence-based conservative treatment, and surgical correction when needed — all within a practice that values your time, respects your preferences, and communicates clearly throughout the care process. Call us at (810) 206-1402 to take the first step toward better foot health.

Our podiatric team brings decades of combined clinical experience to every patient encounter. We stay current with the latest evidence in podiatric medicine and surgery, applying emerging treatments — including EPAT shockwave therapy, MLS laser, PRP injection, and minimally invasive surgical techniques — where the evidence supports their use for specific conditions. Michigan patients can trust that the treatment recommendations they receive at Balance Foot & Ankle reflect the current standard of care, not outdated approaches. Call (810) 206-1402 to schedule at our Howell or Bloomfield Hills office.

Related Treatment Guides

Insurance questions are easy to address before you schedule — call Balance Foot & Ankle at (810) 206-1402 and our insurance team will verify your specific plan’s coverage for the services you need. We accept Blue Cross Blue Shield, Aetna, UnitedHealthcare, Cigna, Priority Health, HAP, and Medicare and Medicare Advantage plans. Our verification process identifies your copay, deductible status, and any prior authorization requirements in advance, so you can make an informed scheduling decision. Both our Howell and Bloomfield Hills locations offer convenient daytime and early morning appointment times to fit busy schedules.

Related Patient Guides

PTTD Treatment Michigan
Flat Feet Pain: Causes & Treatment
Ankle Sprain Recovery Guide
ankle sprain treatment Michigan.michiganfootdoctors.com/custom-orthotics-guide/”>The Complete Guide to Custom Orthotics
12 Signs You Need to See a Podiatrist

Medical References & Sources

Dr. Tom’s Recommended Insoles

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Affiliate Disclosure: This page contains affiliate links to products we recommend. If you purchase through these links, Balance Foot & Ankle may earn a small commission at no additional cost to you. We only recommend products we use with our patients.

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Clinical References

Alvarez RG, et al. Stage I and II posterior tibial tendon dysfunction treated by a structured nonoperative management protocol. Foot Ankle Int. 2006;27(1):2-8.
Chao W, et al. Nonoperative management of posterior tibial tendon dysfunction. Foot Ankle Int. 1996;17(12):736-741.
Neville C, et al. Comparison of changes in posterior tibialis muscle length between subjects with posterior tibial tendon dysfunction and healthy controls during walking. J Orthop Sports Phys Ther. 2007;37(11):661-669.

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.