Posterior tibial tendon dysfunction (PTTD), or what many commonly call adult acquired flatfoot, is a condition caused by changes in the tendon, impairing its ability to support the arch.

PTTD is the most common type of flatfoot developed during adulthood with older people more prone to being afflicted.

“We treat conservatively whenever possible with orthotics,” says Paul Betschart, DPM. “If that’s not enough, we move on to an ankle foot orthotic brace that goes between the foot and the ankle to hold the foot in a proper position to take the strain off the tendon and improve the foot function.”

This will allow the tendon to recover to some degree. However, sometimes the tendon is damaged to the point that they can’t recover and that requires treatment with special injections and growth factors.

“Amniotic tissue injections help to stimulate the healing of the tendon and tries to get it to start working again,” Dr. Betschart says. “If not, we can do a surgical procedure to reestablish the function of the tendon.”

Still, the majority of patients that Dr. Betschart sees with PTTD can have their symptoms controlled with orthotics or bracing, and very few move on to surgery.