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Fallen arches, PTTD, and Plantar Fasciitis can cause foot or ankle pain.

Differences Between Fallen Arches and Plantar Fasciitis

Luke Ferdinands

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Plantar Fasciitis vs. Fallen Arches: Understanding the Difference to Nail Your Treatment

If you're experiencing pain in the arch of your foot, you're probably wondering if it's Plantar Fasciitis, fallen arches, flat feet (flatfoot), or Posterior Tibial Tendon Dysfunction (PTTD). Let's break it down so you can figure out what’s going on and get the right treatment to get you back to doing what you love.

What are Plantar Fasciitis, Fallen Arch, Flatfoot, and PTTD?

Plantar Fasciitis

This is a condition that affects the plantar fascia. Think of the plantar fascia as a thick, supportive band of tissue running along the bottom of your foot. Its job is to support your arch and absorb the shock when you walk or run. When the plantar fascia is loaded more than it can take, it starts to develop tiny tears, leading to inflammation, pain, and scar tissue formation. This is what we call Plantar Fasciitis. With Plantar Fasciitis, you typically have pain in your arch or heel.

Learn more about what Plantar Fasciitis is.

Pain location is one difference between fallen arches and Plantar Fasciitis

Fallen Arches or Flat Foot (Flatfoot)

A healthy plantar fascia forms an arch and acts like a spring to absorb the shock as you go about your day. The arch is supported by small muscles in your foot, calf muscles, tendons, and other tissue. When these tissues are not doing their job effectively, the arch can collapse, flattening your foot. That's what we call Fallen Arches or Flatfoot. One of the conditions that cause Fallen Arches or Flatfoot is called PTTD.

Posterior Tibial Tendon Dysfunction (PTTD)

PTTD (also called Posterior Tibial Tendonitis) affects the posterior tibial tendon, which connects your calf muscles to the inside of your foot. This tendon is a key player in supporting your arch. When it gets overworked or injured, it can’t do its job properly, leading to a collapsed arch or flat feet, which can cause pain in both your arch and your ankle.


In the rest of this article, let's focus on Plantar Fasciitis, and this major cause of Fallen Arches/Flatfeet.

Fallen arches due to PTTD

Similarities between Plantar Fasciitis and PTTD

Even though they affect different parts of your foot, Plantar Fasciitis and PTTD share some common traits:

  1. Repetitive Stress Injuries: Both conditions stem from repetitive stress. Whether you're an athlete or someone who stands for long periods of time, these activities can trigger Plantar Fasciitis and PTTD.
  2. Pain Triggers: Pain from both conditions tends to be worse first thing in the morning when you get out of bed, after standing or walking for a while, and following periods of activity.
  3. Need for Active Treatment: Usually, PTTD and Plantar Fasciitis don't heal on their own. You need to actively work on them. Soft tissue massage encourages healthy tissue repair and physical therapy exercises strengthen your foot muscles.
  4. Gradual Increase in Activity: Recovery involves gradually increasing your activity levels to build strength and prevent further injury.

Key differences between Plantar Fasciitis and PTTD

Despite their similarities, there are some key differences:

  1. Affected Tissues: In Plantar Fasciitis, the plantar fascia ligament at the bottom of your foot gets injured. In PTTD, the posterior tibial tendon, which supports your arch, is the one in trouble.
  2. Pain Location: Plantar Fasciitis usually causes pain in the bottom of the foot, particularly in the arch and heel. PTTD pain is sometimes felt in the arch, but more commonly on the inside of the ankle.
  3. Pain Sensation: Plantar Fasciitis pain is often described as stabbing or throbbing. PTTD pain can feel more like a dull ache or a burning sensation, similar to nerve pain.
  4. Response to Unloading: With Plantar Fasciitis, unloading the injured tissue (taking your weight off the affected foot) can provide immediate pain relief. For PTTD, it takes a bit longer for the pain to subside after unloading.

How to tell if it's Plantar Fasciitis or PTTD

Figuring out whether you have Plantar Fasciitis or fallen arches from PTTD can be tricky, but here are some clues that physical therapists use for diagnosis:

  • Take the Foot and Ankle Pain Quiz: We built the quiz so you can differentiate between Plantar Fasciitis and PTTD and pick the right treatment for you, using the tried-and-true diagnostic tools from physical therapy.
  • Pain Location: Focus on where the pain is most intense. Heel and arch pain typically point to Plantar Fasciitis, while pain inside the ankle suggests PTTD.
  • Specific Tests: In the quiz, we use these tests to differentiate between the conditions:
  • Heel Walk Test: Walking on your heels can highlight issues with the plantar fascia. If you feel pain walking on your heels, you may have Plantar Fasciitis.
  • Heel Raise Test: Trying to raise your heels off the ground while standing can indicate PTTD if you feel pain or have difficulty performing the movement.

Fallen Arches, Flatfoot, PTTD vs. Plantar Fasciitis: Next Steps

  1. Get a Proper Diagnosis: Understanding whether you have Plantar Fasciitis or PTTD is crucial for effective treatment. Our PT-approved foot pain quiz is a first step, or consult a strong physical therapist to get the right diagnosis.
  2. Condition-Specific Treatment: Each condition requires targeted treatment. For Plantar Fasciitis, focus on supporting and reducing the amount of load through the arch, soft tissue massage, and strengthening the entire chain. For PTTD, support the arch, reduce swelling, and strengthen the muscles and tendons that work with the posterior tibial tendon.
  3. Incorporate Physical Therapy: Use the Alleviate App and Guided Recovery Programs to access Plantar Fasciitis and PTTD physical therapy exercises to strengthen the muscles in your feet, all the way up to your calves. This will help support your arches and reduce strain on the injured tissues.
  4. Incorporate Daily Massage: Daily massage using the Arch Massager reduces tension, and encourages healthy tissue repair and growth.
  5. Use a Foot Brace: A foot brace designed to replicate the physical therapy tape job, like the Loft 2 Brace, can provide the necessary support and alleviate pain by taking the load off the affected areas, immediately reducing the pain. Pain relief from the Loft 2 Brace is your first step toward active recovery.
  6. Gradually Increase Activity: Avoid jumping back into high-intensity activities too quickly. Gradually increase your walking or standing time to allow your foot and ankle to adapt and strengthen.
  7. Stay Consistent: Consistency is key. Regularly perform your PTTD and Plantar Fasciitis exercises and follow your treatment plan to achieve lasting recovery.

Understanding the similarities and differences between Plantar Fasciitis and fallen arches from PTTD helps you make informed decisions about your arch pain treatment. With the right diagnosis and targeted approach, you can get back on your feet and enjoy your daily activities without discomfort. Don’t let foot pain hold you back – take charge of your recovery with us!


Key Takeaways

Causes and Affected Tissues: Plantar Fasciitis involves the plantar fascia ligament, causing arch and heel pain, while PTTD involves the posterior tibial tendon, leading to pain in the arch and inside of the ankle.

Common Pain Triggers: Both conditions are caused by repetitive stress and result in pain that is worse in the morning, after prolonged standing or walking, and after activity.

Pain Sensations and Relief : Plantar Fasciitis pain is stabbing or throbbing and improves with rest, while PTTD pain is a burning or dull ache and takes longer to relieve after resting.

Diagnosis and Tests : Pain location and specific tests, like the Heel Walk Test for Plantar Fasciitis and the Heel Raise Test for PTTD, help differentiate between the conditions.

Effective Treatments : Proper diagnosis, targeted exercises, daily massage, supportive foot braces, gradual activity increase, and consistent treatment are essential for recovery for both conditions.

Plantar Fasciitis or PTTD, bring home the treatment that works

The good news is, there are now an effective at-home treatment for Plantar Fasciitis and a home PT treatment for PTTD that let you replicate the gold standard of physical therapy.


Alleviate was founded by a patient-and-clinician duo to bring the effective chronic pain treatment from physical therapy offices to everyone's home. With our Plantar Fasciitis System 2 or PTTD System, you can use the Alleviate Method to recover from these foot or ankle pain conditions at home. You'll get all the guidance, methodology and tools you need to take control of Plantar Fasciitis or PTTD, without a visit to a doctor's office.

Luke Ferdinands, physical therapist and Alleviate co-founder

Luke Ferdinands, Physical Therapist & Co-Founder


A New Zealand-trained physical therapist with over 20 years of experience, Luke developed the Alleviate Method to bring the gold standard of physical therapy care to everyone's home. Luke leads the development of physical tools and digital physical therapy content, focusing on driving clinical outcomes for people with chronic musculoskeletal pain conditions like Tennis Elbow, Plantar Fasciitis, Runner's Knee, and more.