Posterior Tibial Tendonitis Brace: How It Works, and How to Choose the Right PTTD Brace

When you're dealing with Posterior Tibial Tendonitis (PTTD), a good Posterior Tibial Tendonitis brace that relieves pain quickly and supports the injured tendon can be a godsend. However, there isn’t a reliable guide that explains how exactly a PTTD brace works, and what you should look for when choosing one - so we’ve created one!

In this guide, we'll break down the mechanisms of PTTD, explain how a foot brace should help with PTTD pain, and share practical tips for selecting the right brace for your needs.

As a result of the reduced capacity of the tendon to support the healthy shape of your arch, the arch can start to collapse, or flatten out. This is why many people with PTTD also has flat foot (also called the flatfoot deformity) or fallen arches.

The tendon has another important function: to prevent your foot from tilting too far inwards when you walk. So, when you develop PTTD, your foot can start tilting inward (toward the center of your body). This is called overpronation, and can lead to malalignment and pain in other parts of your lower body, particularly in your knees. This is one reason we often see Posterior Tibial Tendonitis developing together with Runner's Knee.

A telltale sign of overpronation, whether you have Posterior Tibial Tendonitis or not, is when you walk on the inside of your feet. This often causes uneven wear on your shoes, with the inside wearing much faster than the outside.

People with PTTD typically experience ankle pain on the inside, where the tendon is located. This pain can also extend to the arch and even the small muscles around it, as they struggle to compensate for the injured tendon, as well as the collapsing arch.

To effectively treat Posterior Tibial Tendonitis, you need to reduce the stress on the tendon and give additional support to the falling arch. Physical therapists often start with a technique called low-dye taping, which uses tape to create a fulcrum that lifts the arch and unloads the tendon.

A brace for Posterior Tibial Tendonitis should be designed to replicate these benefits of professional tape job, providing continuous support throughout the day.

Low-dye taping works by lifting the arch and reducing the load on the posterior tibial tendon. With low-dye taping, the tendon doesn't have to work as hard to maintain the shape of the arch, which helps relieve pain in both the tendon and the arch.

While low-dye taping is effective, it has its limitations. Tape wears out quickly. During higher-intensity activities, taping often loses its effectiveness within 30 minutes of application. So, taping requires regular reapplication, which can be time-consuming to do yourself and impractical if you need a professional to do it for you.

The primary reason you want to wear a PTTD brace is its ability to lift the arch and unload the tendon so you can stay active as you heal. It's important to note that the current literature doesn't support the notion that you need to immobilize the ankle to treat PTTD.

Rigid braces that come up far above the ankle to keep it from rolling sideways do help with ankle stability. However, that's not necessary to heal this condition - and worse, this type of PTTD brace can keep you from doing what you love to do, because they are difficult to move around in. The key to effective PTTD treatment is smart load management, not immobilization.

When selecting a PTTD brace, consider these five factors to ensure you get the right support for your needs.

The material of the brace plays a significant role in its effectiveness.

• While neoprene is a popular choice, it's too stretchy to provide the necessary support.
• Instead, look for a material with enough structure to lift the arch while still offering a slight give to contour to your foot.
• A 3D knit material is a good choice, as it strikes a balance between support and flexibility.
• Avoid materials that are too rigid, such as ballistic nylon or canvas-like fabrics; they are not a comfortable, form-fittng material, especially for frequent use.

The construction of the brace is another important consideration.

• A cross-strap design is often used in ankle braces to immobilize the joint, but this isn't necessary for PTTD. In fact, a cross-strap design is a telltale sign that the brace is generic and not specifically designed for PTTD.
• Instead, look for a brace with lacing or adjustable Velcro that allows for a customizable fit.
• Adjustability is important because your feet naturally swell throughout the day, and you need to be able to adjust the fit quickly.
• Make sure the brace has a mechanism to lift the arch and unload the tendon - that’s a must for a Posterior Tibial Tendonitis brace.

A brace that's comfortable and convenient to wear is the one you'll actually use.

• Look for features like breathability, which allows you to wear the brace for extended periods, even during sweaty activities.
• The brace should also be machine-washable and durable enough to withstand regular use.
• Finally, make sure the brace is low-profile enough to fit into your athletic shoes, so you can wear it during your favorite activities.

While some people with PTTD find extra ankle stability helpful, it's important to avoid braces that completely immobilize the ankle. Immobilizing the ankle can actually be counterproductive for PTTD, as it interferes with the smooth up-and-down movement of the tendon inside the ankle. Over time, not letting the tendon work at all will weaken the tendon further, reducing its ability to support the arch and increasing the risk of recurrence.

A good PTTD brace doesn't need to cover your entire ankle, but it should provide some height for effective support.

• Think of the low-dye tape job: the anchor point near the top of your foot creates a lever to unload the arch, but this anchor doesn't extend too far up the ankle, except in severe cases.
• If the brace ends below the top of your shoe, though, it cannot provide enough leverage to unload the injured tendon effectively.
• The same goes for bands that only go around your arch. They have no leverage at all to lift the arch.

While a well-designed PTTD brace is our recommendation, there are several alternatives that you might consider. Let's break down the pros and cons of these options.

Orthotics can fit into many shoes and provide arch support by pushing up the arch. However, they don't lift the arch in the same way a low-dye tape job or brace can. As a result, orthotics are not be as effective at unloading the posterior tibial tendon.

Foot bands are low-profile and can be worn inside your shoes, but they don’t have enough compression to combat swelling, and can’t provide the anchor points needed to effectively lift the arch and unload the tendon. As a result, you won’t get the same level of support from foot bands as you would from a purpose-built brace for Posterior Tibial Tendonitis.

PTTD boots that go up very high can help stabilize the ankle by preventing sideway rolling of the ankle. However, preventing the ankle from moving sideways don't unload the tendon like an arch-lifting brace can.

Furthermore, rigid boots stop you from being active, leading to more weakening of the whole kinetic chain, which raises the likelihood of flare-ups. For these reasons, we generally don’t recommend rigid boots for PTTD treatment.

Posterior Tibial Tendonitis can be a challenging condition to manage, but with the right brace, you can alleviate pain and start healing the damaged tendon. Choose a brace that’s designed to lift the arch, provide the right amount of support, and allow for ankle mobility you need to stay active.

With a good brace, you can reduce the load on the posterior tibial tendon and get back to doing the activities you love, even as you work toward full resolution.

Remember, smart load management is one of the four keys to long-term resolution. (Compression is another!)

The gold standard of non-invasive, active treatment for Posterior Tibial Tendonitis incorporates four components that work together:

• Load management: Wear a brace to help maintain the arch and reduce the load that the injured tendon has to support.
• Venous return: Wear compression socks to encourage fluid drainage and reduce ankle swelling.
• Progressive strengthening: Gradually increase strength throughout the kinetic chain by following a program of eccentric strengthening exercises.
• Soft tissue mobilization: Massage the small muscles and tendons that support the arch to reduce pain, release tension, and encourage the growth of healthy tissue.

This is the basis of the Alleviate Method, developed to bring the effective treatment methodology and tools to everyone's home. Our PTTD System uses the Alleviate Method to get you back to doing what you love, without a visit to a doctor's office. Check it out, and let us know if we can answer any questions!