What does a podiatrist treat?

Podiatrists specialize in the foot, ankle, and lower leg. They diagnose and treat heel pain, bunions and hammertoes, tendon injuries, nerve conditions (Morton's neuroma, neuropathy), toenail disorders, skin conditions (warts, calluses, ulcers), fractures, sports injuries, diabetic foot complications, ankle instability, and perform foot and ankle surgery. At Balance Foot & Ankle, Dr. Tom Biernacki DPM, Dr. Carl Jay DPM, and Dr. Daria Gutkin DPM AACFAS serve Howell, Bloomfield Hills, and surrounding Michigan communities.

How often should a healthy person see a podiatrist?

Annual foot exams are beneficial if you are over 60, are an active runner or athlete, have diabetes, have a family history of foot problems, or notice any changes in foot shape, nail appearance, or skin texture. Preventive visits catch problems early — before bunions require surgery or a small nail issue becomes an infection.

Can foot problems cause knee, hip, or back pain?

Yes — the foot is the foundation of the kinetic chain. Overpronation causes the tibia to internally rotate, increasing stress on the knee and altering hip alignment. High arches transmit shock poorly, overloading the ankle and knee. Custom orthotics that correct foot mechanics frequently improve knee, hip, and back symptoms — one of the most underappreciated benefits of podiatric care.

When should I see a podiatrist versus an orthopedic surgeon?

Podiatrists specialize exclusively in the foot, ankle, and lower leg — making them the most experienced providers for most foot and ankle conditions. For foot and ankle surgery, a DPM with high case volume is appropriate. Dr. Tom Biernacki at Balance Foot & Ankle has performed over 3,000 foot and ankle procedures. Call (810) 206-1402.

Posterior Tibial Tendon Dysfunction 2026 | Podiatrist

Medically reviewed by Dr. Tom Biernacki, DPM

Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026

Tibialis Posterior Tendon Dysfunction Flatfoot Stage Michigan - Michigan podiatrist, Balance Foot & Ankle — Tibialis Posterior Tendon Dysfunction Flatfoot Stage Michigan treatment | Balance Foot & Ankle, Michigan

Stage	Description	Deformity	Single-Heel Rise Test	Treatment
Stage I	PTT tenosynovitis; tendon intact; no deformity	None or minimal	Normal — can perform multiple heel rises	Orthotics + PT; boot for acute flare; tenosynovectomy if failed
Stage IIA	Tendon elongation or partial tear; flexible flatfoot; <30% forefoot abduction	Flexible hindfoot valgus	Weak or cannot perform single heel rise	Medial displacement calcaneal osteotomy + FDL transfer
Stage IIB	Flexible flatfoot; ≥30% forefoot abduction; lateral subfibular impingement	Moderate flexible deformity	Cannot perform	MDCO + lateral column lengthening + FDL transfer ± Cotton osteotomy
Stage III	Rigid hindfoot valgus; subtalar arthrosis beginning	Rigid — cannot be manually corrected	Cannot perform	Triple arthrodesis (subtalar + calcaneocuboid + talonavicular)
Stage IV	Stage III + deltoid ligament insufficiency; valgus ankle tilt	Rigid + ankle valgus	Cannot perform	Triple arthrodesis + deltoid ligament reconstruction or total ankle replacement

Procedure	Stage	Purpose	Recovery	Notes
FDL Tendon Transfer	II–IIB (all flexible stages)	Replaces dysfunctional PTT; restores medial column inversion	6–8 weeks NWB; 4–5 months sport	Combined with bony procedures; FDL harvested at knot of Henry
Medial Displacement Calcaneal Osteotomy (MDCO)	IIA + IIB	Shifts calcaneal tuberosity medially; corrects hindfoot valgus	6–8 weeks NWB	8–10mm medial shift; locked plate or screw fixation
Lateral Column Lengthening (Evans osteotomy)	IIB (significant forefoot abduction)	Lengthens lateral column; corrects forefoot abduction	6–8 weeks NWB	Structural graft (allograft or iliac crest) inserted into anterior calcaneus
Cotton Osteotomy (medial cuneiform)	IIB (residual forefoot supinatus)	Plantarflexes medial column; corrects forefoot varus	4–6 weeks NWB	Opening wedge; structural graft; used when forefoot supinatus persists after hindfoot correction
Triple Arthrodesis	III–IV	Fuses subtalar, CC, and TN joints; creates stable plantigrade foot	8–12 weeks NWB; 6 months full activity	Gold standard for rigid deformity; high patient satisfaction 85–90%

Quick answer: Tibialis Posterior Tendon Dysfunction Flatfoot Stage Michigan is a common foot/ankle topic that affects many patients. The 2026 evidence-based approach combines proper diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Hills practices. Call (810) 206-1402.

Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan

https://www.youtube.com/watch?v=8opvH3qxkW4

Dr. Biernacki explains posterior tibial tendon dysfunction and adult flatfoot progression—and how surgical reconstruction restores the arch.

Podiatrist evaluating posterior tibial tendon dysfunction adult flatfoot deformity for surgical planning

Watch: How to Fix Flat Feet? [Collapsing Arch Pain & Flat Foot Correction!] — MichiganFootDoctors YouTube

Watch: Ankle conditions & surgical options

MICHIGAN PODIATRIST INSIGHT

The most important clinical decision with Tibialis Posterior Tendon Dysfunction Flatfoot Stage Michigan isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.

MICHIGAN PODIATRIST INSIGHT

Understanding Posterior Tibial Tendon Dysfunction

The posterior tibial tendon (PTT) is the primary dynamic support of the medial longitudinal arch. It courses behind the medial malleolus and inserts on the navicular and plantar midfoot bones, inverting the foot and lifting the arch during walking. When this tendon degenerates and fails—a process occurring gradually in middle-aged and older adults, more commonly women—the arch collapses, the heel everts into valgus, and the forefoot abducts. This progressive adult-acquired flatfoot deformity is termed Stage I through Stage IV PTTD based on tendon integrity and deformity rigidity.

Staging PTTD and Why It Matters

Stage I PTTD involves tendon inflammation without deformity—the arch is preserved and the tendon is intact but symptomatic. Stage II PTTD features partial or complete tendon rupture with a flexible (reducible) flatfoot deformity—the classic “too many toes” sign and inability to perform a single-leg heel rise. Stage III PTTD presents with a rigid flatfoot deformity and early subtalar and peritalar arthritis. Stage IV PTTD includes valgus tilting of the talus within the ankle mortise with tibiotalar arthritis. Staging dictates treatment—flexible deformities are correctable; rigid deformities may require fusion procedures.

Clinical and Imaging Evaluation

Dr. Biernacki assesses arch height, heel valgus, forefoot abduction (“too many toes” sign), single-leg heel rise ability, subtalar flexibility, and ankle alignment. Weight-bearing foot and ankle X-rays quantify deformity angles—talo-first metatarsal angle, calcaneal pitch, and hindfoot alignment. MRI characterizes tendon integrity, spring ligament status, and tarsal joint cartilage quality. These findings together determine stage and guide the selection between conservative bracing and surgical correction.

Conservative Treatment: Orthotics and Bracing

Stage I and early Stage II PTTD respond to aggressive conservative management. UCBL custom orthotics with medial wedging support the arch and reduce PTT strain during walking. The Arizona ankle-foot orthosis (AFO) provides medial hindfoot control for more significant Stage II deformity or when UCBL orthotics are insufficient. A removable walking boot during acute tendinitis flares reduces inflammation. NSAIDs and ultrasound-guided peritendinous corticosteroid injections address active tendon inflammation. Aggressive physical therapy with eccentric PTT strengthening is indicated for Stage I patients.

Surgical Flatfoot Reconstruction

Flexible Stage II and Stage III PTTD that fails conservative care requires surgical reconstruction. The standard procedure combines a medializing calcaneal osteotomy (shifting the heel inward to correct valgus alignment), flexor digitorum longus (FDL) tendon transfer to replace the failed posterior tibial tendon, and spring ligament repair to restore the primary static arch support. Cotton osteotomy of the medial cuneiform corrects forefoot supination in severe deformity. Stage III rigid flatfoot with subtalar arthritis may require subtalar or triple arthrodesis in addition to these procedures. Dr. Biernacki tailors the reconstruction plan to each patient’s specific deformity pattern and arthritis distribution.

Recovery After Flatfoot Reconstruction

Flatfoot reconstruction requires a longer recovery than many podiatric procedures. Non-weight-bearing with crutches or a knee scooter is maintained for six to eight weeks while osteotomies heal. Progressive weight-bearing in a boot follows from weeks six to twelve. Physical therapy rehabilitation begins at six weeks. Return to supportive athletic footwear with custom orthotics occurs at four to six months; return to impact sports at six to nine months. Long-term success requires lifetime use of supportive footwear and custom orthotics to protect the reconstructed arch.

Dr. Tom's Product Recommendations

Arizona AFO Ankle Brace (Aspen Medical)

⭐ Highly Rated

Over-the-counter Arizona-style AFO provides medial hindfoot support and arch control for Stage II PTTD patients who need more support than a UCBL orthotic provides.

Dr. Tom says: “For moderate Stage II PTTD, an Arizona-style brace often bridges the gap between orthotics and surgery—providing the medial support the failing PTT can no longer deliver.”

✅ Best for
Stage II PTTD patients with flexible flatfoot needing daily medial support

⚠️ Not ideal for
Stage III/IV patients with rigid deformity requiring surgical correction

View on Amazon →

Disclosure: We earn a commission at no extra cost to you.

Powerstep ProTech Full Length Orthotic

⭐ Highly Rated

Maximum-support arch orthotic with deep heel cup and firm medial arch—useful for early Stage I PTTD patients who need aggressive arch support while custom UCBL orthotics are fabricated.

Dr. Tom says: “For early PTTD, aggressive arch support from a firm insole can slow progression while we get custom orthotics fabricated.”

✅ Best for
Stage I PTTD patients with early tendon inflammation and flexible flatfoot

⚠️ Not ideal for
Stage II-IV patients with significant deformity requiring custom UCBL or Arizona AFO

View on Amazon →

Disclosure: We earn a commission at no extra cost to you.

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Dr. Tom Biernacki’s Recommendation

PTTD is one of those conditions where early intervention makes an enormous difference. A Stage I patient can often be managed successfully with an orthotic and physical therapy. A Stage III patient may need a complex reconstruction with a long recovery. Don’t wait until the flatfoot becomes rigid—come in when you notice the arch collapsing or developing medial ankle pain.

— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle

Frequently Asked Questions

What does too many toes sign mean?

When viewed from behind, a normal foot shows one or two toes lateral to the heel. In PTTD flatfoot with forefoot abduction, three, four, or even five toes are visible—the ‘too many toes’ sign indicating significant deformity.

Can I avoid surgery for posterior tibial tendon dysfunction?

Stage I and mild Stage II PTTD can often be managed long-term with custom orthotics, Arizona bracing, and activity modification. Significant Stage II deformity with failing single-leg heel rise and rigid Stage III deformity generally require surgical reconstruction.

Is flatfoot reconstruction painful?

Post-operative pain is managed with nerve blocks, oral medications, and elevation. Most patients are comfortable within one to two weeks. The extended non-weight-bearing period is the main challenge of recovery.

How long do flatfoot reconstruction results last?

With proper reconstruction technique, appropriate patient selection, and lifetime orthotic use, excellent results last decades. Recurrence is uncommon when all deformity components are addressed surgically.

Michigan Foot Pain? See Dr. Biernacki In Person

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Visit Balance Foot & Ankle — Same-Day Appointments Available

Our podiatry team serves patients throughout Michigan including Howell, Brighton, and Bloomfield Hills. If you’re dealing with heel pain, ingrown toenails, or a foot injury, we have same-day appointment availability.

AAOS: Posterior Tibial Tendon Dysfunction

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4.9★ | 1,123 Reviews | 3,000+ Surgeries

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.