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PTTD GUIDE · INNER ANKLE & ARCH PAIN
That burning or dull ache on the inside of your ankle is often Posterior Tibial Tendon Dysfunction (PTTD), also called Posterior Tibial Tendonitis. Learn what causes it, how to check for it at home, and how physical therapists treat it, then follow the same approach yourself.
Shop the PTTD System✅ HSA/FSA eligible · Designed by physical therapists · 30,000+ people helped since 2021
01 · UNDERSTAND THE CONDITION
PTTD (Posterior Tibial Tendon Dysfunction), also known as Posterior Tibial Tendonitis, is a repetitive stress injury of the posterior tibial tendon. This tendon runs along the inside of your ankle and holds up the arch of your foot, absorbing shock and keeping you stable with every step.
It develops when the load on the tendon is more than it can handle. Tiny tears and inflammation cause pain on the inside of the ankle, and as the tendon weakens, the arch can flatten. That's why PTTD is behind many cases of flat feet, fallen arches, overpronation, and Adult Acquired Flatfoot Deformity (AAFD).
The good news: because PTTD comes down to a mismatch between load and capacity, it responds well to a physical therapy approach that takes load off the tendon now and rebuilds its capacity over time.
AT A GLANCE
02 · RECOGNIZE THE CONDITION
PTTD affects an estimated 3–10% of people, yet it's often overlooked or misdiagnosed. Many people who see our co-founder, physical therapist Luke Ferdinands, don't know they have it until he assesses them.
When to see a doctor: It's always best to get an accurate diagnosis of PTTD from a physician, podiatrist, or physical therapist before starting treatment. See a doctor promptly if your ankle pain followed a fall, twist, or pop; if you can't put weight on your foot; if swelling is severe or the area is red and warm; or if you have numbness or tingling.
03 · TEST IT AT HOME
PTTD can be tricky to pin down, even for podiatrists and physical therapists. Two clues help most: where the pain is (on the inside of the ankle, usually just below the ankle bone) and how your ankle handles a heel raise. Watch our physical therapist walk you through the heel raise test.
Stand on both feet and rise up onto your toes. If you feel pain on the inside of your ankle, or have trouble doing the movement, it can point to PTTD.
A positive test isn't a diagnosis on its own. Use it alongside where your pain is, and confirm with a physician, podiatrist, or physical therapist.
Still not sure? Take the foot & ankle pain quiz →04 · TREAT IT
The Alleviate Method follows the same four-part approach a PT uses for PTTD: take load off the injured tendon, reduce the swelling around it, release the small foot muscles that support the arch, then progressively rebuild strength from your foot to your hip.
Why it works: PTTD is a mismatch between load and capacity. Bracing lowers the load right away to protect the tendon from further damage, compression reduces swelling in the foot and ankle, massage can relieve fatigue in the foot arch, and strengthening exercises progressively load the tendon to rebuild its capacity to handle the load so the pain stays away.
STEP 1 · LOAD MANAGEMENT
PTs use low-dye taping to lift the arch like a suspension bridge, so the injured tendon doesn't have to work as hard. Reducing the load protects the tendon from further aggravation, relieves pain right away, and gives it the break it needs to start healing.
You'll use: the Loft 2 Brace, designed to replicate a PT's low-dye tape job
STEP 2 · SWELLING
Excess fluid around the ankle keeps the tendon from gliding smoothly, worsens inflammation, and slows healing. PTs recommend compression of at least 20 mmHg to push that fluid out and reduce swelling.
You'll use: Performance Compression Socks (20+ mmHg)
STEP 3 · MOBILIZATION
Soft tissue mobilization (massage) reduces pain and releases tension in the small foot muscles that work with the posterior tibial tendon, so they can share more of the load. Precise, deliberate pressure works better than a ball or roller.
You'll use: the Arch Massager
STEP 4 · STRENGTHENING
Six levels of progressive exercises restore strength and stability from your foot to your hip, fixing the weak links that overload the tendon. Follow-along videos and progress checks tell you exactly what to do and when to move up, in about 15 minutes a day.
You'll use: the PTTD Guided Recovery Program, in the PTTD System or on its own
See how the Loft 2 lifts the arch like a PT's tape job: our physical therapist explains how the brace was designed for PTTD and Plantar Fasciitis.
05 · SHOP THE SOLUTION
Get the PTTD System for all four tools — the Loft 2 Brace, Performance Compression Socks, Arch Massager, and the Guided Recovery Program — or start with the pieces you need. Designed by Alleviate co-founder and physical therapist Luke Ferdinands.
✅ The PTTD System is HSA/FSA eligible — use your pre-tax health funds at checkout.
06 · WHAT TO EXPECT
PTTD builds up over time, and recovery takes consistent effort too. With 10–15 minutes of daily work, here's what Alleviate users report.
DAY 1
Immediate support. Lifting the arch takes load off the injured tendon right away, the same way a PT's low-dye tape job does.
FIRST 7 DAYS
Quick progress. On average, Alleviate System users report a 20% reduction in pain within the first week.
ABOUT WEEK 6
Lasting progress. PTTD System users report an average 60% pain reduction within six weeks.
Based on Alleviate user-reported outcomes. Individual results vary.
07 · WHO TRUSTS IT
“I purchased the package for PTTD and it is the only thing that has worked… Since I’ve been wearing the brace I have seen a marked improvement… the band for arch support is magic. I even went on a little hike (with brace on) and did not feel like I was backsliding… These guys are the real deal.”
PTTD System user
“After 10+ months of plantar fasciitis and PTTD in both feet… I was skeptical, but desperate after changing out all of my shoes, seeing a podiatrist and a PT and getting injections. After two weeks of using the app every day, my pain is reduced by about 30–50%… It really does work!”
PTTD System user
“Alleviate is a one-stop shop for pain relief and long-term results. It's a no-brainer for my patients with chronic pain.”
Podiatrist
08 · FAQ
Still deciding? These are the questions we hear most from people dealing with inner ankle and arch pain.
The PTTD System gives you the four tools a physical therapist uses for PTTD — the Loft 2 Brace, Performance Compression Socks, the Arch Massager, and a guided strengthening program — for 10–15 minutes a day at home.
Start my recovery✅ HSA/FSA eligible · Designed by physical therapists
This information is educational and isn't a substitute for medical care. If your ankle pain is severe or sudden, followed a fall, twist, or pop, or you can't put weight on your foot, see a doctor.
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