Inside of Ankle Pain Treatment: How to Treat PTTD Ankle Pain at Home, Using 4 Physical Therapy Principles

There are several causes of ankle pain, but if you have pain inside of the ankle, PTTD (Posterior Tibial Tendon Dysfunction or Posterior Tibial Tendonitis) should be at the top of your suspect list. A repetitive stress injury, PTTD can cause significant pain on the inside of the ankle, swelling around the ankle, and arch pain. Luckily, physical therapy has developed an effective approach to treating ankle pain from PTTD, and it’s even possible to apply the principles at home. Let’s take a look at the four principles of effective ankle pain treatment.

Weakened by microscopic tears (and, eventually, scar tissue that forms as a part of the natural healing process), the ability of the posterior tibial tendon to maintain the healthy spring of the arch gets diminished. The arch flattens, with less ability to absorb the impact of your activities. This is why some people with PTTD develop flatfoot and arch pain.

Arch pain from this condition is sometimes confused with Plantar Fasciitis pain. Here are the key differences between fallen arches and Plantar Fasciitis.

PTTD is an ankle condition at its core, but its symptoms aren’t necessarily limited to the ankle; the condition can negatively impact the biomechanics of your whole lower body. Sometimes, a flattened arch is accompanied by overpronation - where your arch falls inward, and you end up walking on the inside of your foot. Some people with PTTD also experience knee pain from knees tilting inward, as well as hip pain.

Many people with PTTD also experience swelling around the ankle. Most people, even without any medical condition, have some level of excess fluid accumulation in our feet from pure gravity, but this is often more pronounced with PTTD.

If these symptoms ring a bell but you aren’t sure if your ankle pain is from PTTD, take our Ankle Pain Quiz.

Accumulation of excess fluid in the ankle causes the swelling that’s often associated with PTTD. The posterior tibial tendon needs to move up and down smoothly within the ankle to support the arch as it flexes with your foot’s movement, and ankle swelling interferes with this movement.

Worse, this excess fluid contains waste materials and is usually acidic, which worsens inflammation and slows down tissue healing. So, to speed up PTTD recovery, PTs often recommend wearing compression socks with at least 20 mmHg of compression to promote venous return and reduce swelling.

Many factors can contribute to the overloading of the posterior tibial tendon - you may be running longer distances, have gained a few pounds, or started a new job that keeps you on your feet all day. But one of the major contributors is weakness anywhere in the whole kinetic chain that forces the posterior tibial tendon to work overtime.

Physical therapists also directly manipulate the small muscles in the foot that work with the posterior tibial tendon to keep the healthy arch. The technical term for massage is (Instrument-Assisted) Soft Tissue Mobilization. Soft tissue mobilization reduces pain and releases the tension in the small muscles so that they can take the load more effectively, reducing the load that the injured tendon has to carry.

You can quickly relieve ankle pain and resolve the root cause of PTTD yourself, when you apply these four physical therapy principles. Going to a PT office twice a week or more is a logistical and financial challenge for many of us. Being able to self-treat PTTD not only removes these barriers, but also lets you apply treatment more frequently and consistently - and that can mean quicker recovery.

What does effective PTTD self-treatment look like? You can try to assemble your own treatment toolkit, but we recommend going with our PTTD System, built by our co-founder, Luke, translating the PT tools and techniques he uses in his own PT practice.

With the PTTD System, you get everything you need to treat your ankle pain and swelling, and Luke will guide you through the recovery program - it’s the simplest way to treat PTTD at home. Each of the four tools included in the PTTD System replicates the four principles of PT treatment:

Like any chronic injuries, PTTD treatment takes some time, effort, and persistence, whether you do it at home, or at your physical therapist's office. We designed the PTTD System so that every effort you put into your recovery has a scientific reason, and moves you that much closer to full recovery. Get started today - we'll guide you all the way to your goal!