How Orthotics Can Treat Help Posterior Tibial Tendonitis

If you have posterior tibial tendonitis, sometimes referred to as posterior tibial tendon (PTT) dysfunction, you may benefit from working with a physical therapist to help decrease your pain and improve your mobility. Your therapist or healthcare provider may recommend orthotics or shoe inserts to help manage the symptoms of your PTT dysfunction. Shoe inserts for posterior tibial tendonitis are used to improve your foot position and raise or support your foot's medial arch, thus relieving stress and strain from your tibialis posterior tendon.

But are orthotics really necessary?

Foot hovering over orthotic shoe insert
michelangeloop / Getty Images

Foot Position and PTT Dysfunction

Your physical therapist will assess your foot position during your initial evaluation for PTT dysfunction. Why? Because many people with PTT problems have a fallen medial (or inside) arch in their foot. This is often referred to as adult-acquired foot deformity or pes planus. As your arch falls and your foot flattens out, stress and strain may be placed upon your tibialis posterior tendon in your lower leg, and this can lead to pain on the inside aspect of your ankle and foot.

Here's the interesting thing: not everyone with acquired foot deformity gets posterior tibial tendonitis, and not everyone with PTT dysfunction has a fallen medial arch. That's why your treatment should be individualized. And your physical therapist can help determine the best treatment for your specific condition. Using orthotics for PTT dysfunction may be one component of your rehab program.

Correcting Foot Position With Orthotics

So what do orthotics really do for your feet? Simply put, they bolster up the medial arch, supporting the inner aspect of your foot. This — in theory — places your foot and your posterior tibial tendon in the optimum position to function properly. A properly functioning tendon doesn't hurt, and your walking and running can return to normal.

There are different types of orthotics. Off-the-shelf shoe inserts can be purchased at your local shoe store or pharmacy. They are generic orthotics that you place in your shoes to give more support to your feet. For some people with PTT dysfunction, these may be enough. They are typically low cost, but they are not customized to your exact foot position.

Custom molded orthotics are another option for people looking to support their medial arch. These are molded to fit your feet by a PT or orthotist. They take a few weeks to make; often your PT or orthotist will take a cast of your feet and then send those casts to an orthotics manufacturer. The orthotics are made according to your specific foot casts. The big problem with custom orthotics: they can be expensive. Many custom shoe inserts can cost $300 to $500 (US). The high cost may make you pause and think twice before purchasing custom inserts for your PTT dysfunction. But if they help your condition, they may be worth it.

The big question to answer when thinking about orthotics for PTT dysfunction: do they really work?

What the Research Shows

One way to assess the effectiveness of orthotics (or any other treatment) for PTT dysfunction is to examine the published scientific research about the condition. First things first: do orthotics actually change the position of your foot to reduce loading of the posterior tibial tendon?

A study published in 2016 examined the ankle and foot positional changes that occur with using two different types of orthotics and a standard shoe. 15 participants with PTT dysfunction had their walking analyzed while wearing different types of shoes and orthotics. The researchers found that using a custom orthotic with a special lateral extension helped to correct the participants' foot position and walking better than using a standard walking shoe.

Another study examined the pain and disability levels in 25 patients (10 men and 15 women) with posterior tibial tendonitis. Data were initially collected regarding patients' pain level and functional loss, and then each subject wore orthotics for 6 weeks. The researchers found there was a decrease in pain and disability levels over the 6 week period of time while using the orthotics.

One problem with the study: there was no control group. All subjects wore orthotics, so it is not known whether the improvements seen were due to the orthotics or simply the passage of time. Perhaps some other unforeseen variable caused the improvements seen in the study.

Bottom line: orthotics can correct the position of your foot, and they may help decrease pain and functional loss due to PTT dysfunction.

How Physical Therapy Can Help PTT Dysfunction

If you do have PTT dysfunction, evidence shows that you may benefit from stretching exercises. Your healthcare provider may recommend that you work with a physical therapist to help improve your PTT symptoms and return to your previous level of function. Your PT can assess your specific condition and prescribe the best treatments for you. Rehab for posterior tibial tendonitis may include:

If your PT feels that your foot and ankle position is causing excessive stress on your tibialis posterior tendon, he or she may recommend orthotics because they can change your foot position and may help to decrease pain and improve function. Understanding why you are wearing orthotics and what needs they serve can help you make the best choice for your specific condition.

A Word From Verywell

Orthotics are a popular treatment choice for people with posterior tibial tendon problems. If you suffer from this condition, you may benefit from using them to decrease your pain and improve your mobility. Your treatment for PTT dysfunction needs to be individualized for your specific condition. By working closely with your physical therapist, you can decide if orthotics are right for you, and you can quickly and safely return to your previous level of activity.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Kulig K, Reischl SF, Pomrantz AB, et al. Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise: a randomized controlled trial. Phys Ther. 2009;89(1):26-37. doi:10.2522/ptj.20070242

  2. Smyth NA, Aiyer AA, Kaplan JR, Carmody CA, Kadakia AR. Adult-acquired flatfoot deformity. Eur J Orthop Surg Traumatol. 2017;27(4):433-439. doi:10.1007/s00590-017-1945-5

  3. Bek, N. et al. The effect of orthotic treatment of posterior tibial tendon insufficiency on pain and disabilityThe Pain Clinic. 2003;15(3):345-50. doi:10.1163/156856903767650907

  4. Neville C, Bucklin M, Ordway N, Lemley F. An ankle-foot orthosis with a lateral extension reduces forefoot abduction in subjects with stage II posterior tibial tendon dysfunction. J Orthop Sports Phys Ther. 2016;46(1):26-33. doi:10.2519/jospt.2016.5618

  5. Houck J, Neville C, Tome J, Flemister A. Randomized controlled trial comparing orthosis augmented by either stretching or stretching and strengthening for stage II tibialis posterior tendon dysfunction. Foot Ankle Int. 2015;36(9):1006-16. doi:10.1177/1071100715579906

Additional Reading
  • Bek, N. et al. The effect of orthotic treatment of posterior tibial tendon insufficiency on pain and disability. The Pain Clinic; 15(3). Published online 2013: 345-50.
  • Neville, C. et al. An ankle-foot orthosis with a lateral extension reduces forefoot abduction in subjects with stage II posterior tibial tendon dysfunction. JOSPT; 46(1) 2016: 26.-33.

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.