The purpose of your arch (between the heel and ball of your foot) is to help absorb the shock of walking, facilitate movement, and provide additional balance and stability. Your arch is supported by a network of muscles, tendons, and ligaments, but your Posterior Tibialis Tendon is the main tendon that supports your arch.

What is a Collapsed Arch?

The Posterior Tibialis Tendon travels down the inside of the lower leg, ankle and foot making it one of the major supporting structures of the foot. Years of physical activity walking, running, or even just prolonged standing can weaken your Posterior Tibial tendon causing it to become strained resulting in pain, inflammation and stretching and over time causes the arch along the inside of the foot to become flatter.

Overloading this tendon through injury or repetitive strain can cause inflammation, called tendonitis, and even tearing. Once your posterior tibial tendon is damaged, your arch loses its support system and can flatten out, which results in fallen arches.

This is clinically known as Posterior Tibial Tendon Dysfunction (PTTD).

Signs and Symptoms

A collapsed arch may not necessarily cause pain but you may notice:

  • Ankle stiffness
  • Pain and swelling along the inside of the ankle which can range from mild to severe
  • Pain and swelling may increase with prolonged walking and activity or at the end of the day
  • Foot and ankle weakness as though there is a loss of strength when you lift your heel off the ground walking
  • Inability to raise up onto tip toes
  • You may notice your ankles roll inwards and your foot becomes flatter
  • Pain on the outside of your ankle as the foot becomes flatter and its position changes
  • You may suffer tingling, shooting, burning or stabbing as a result of inflammation of the nerve inside the tarsal tunnel which travels beside the tendon

Causes/risk factors

Anybody can suffer with this condition however it is common in:

  • Females aged over 40 years old
  • Occupations involving prolonged standing
  • Following acute injuries such as falls and ankle sprains
  • Those who have had previous ankle injuries that cause inflammation and tears to the tendon
  • Having flat feet places a greater strain on the tendon
  • Overuse of the tendon, altered foot mechanics and pressure distribution due to the shape of the foot or joint changes can also cause overuse
  • Obesity increases the weight placed on your feet and therefore additional strain on the tendon
  • Ageing causes tendons to lose their elasticity and ability to glide as smoothly increasing the risk of dysfunction
  • Systemic conditions such as high blood pressure, Diabetes and Rheumatoid arthritis can weaken tendons.
  • Footwear – wearing slip on shoes, backless (flip flops) or soft heel counter footwear causes an increased strain on the tendon
  • Repetitive heavy impact on the feet for example during sports and dancing


PTTD is a chronic progressive condition so is easier treated in the early stages preventing the need for surgery. Physiotherapy can provide customised exercises and stretches needed to retore the functionality of your feet and ankles. You may also be advised the following:


Resting the tendon by reducing your walking, standing and high impact activity and apply an ice pack (or frozen vegetables covered with a towel to prevent ice burns) for 10 minutes, four times a day can reduce pain and inflammation.


If you are overweight losing weight will reduce the load going through your feet when you are standing or walking.


Reduce strain and pressure on the tendon by wearing comfortable shoes, trainers or hiking boots which have a high and firm heel counter with arch support.

Avoid slip–on or backless shoes as they usually have a soft and low heel counter and therefore increase strain on the ankle and tendon.  In some cases, you may benefit from wearing specially made orthotic shoes or boots to help support the tendon and reduce the pain.


Taking pain killers such as paracetamol and ibuprofen when needed to reduce pain and inflammation.


Wearing orthotics can reduce forces around this area and reduce strain on the tendon, allowing time for the tendon to heal whilst giving pain relief.


Surgery may be offered if other treatment options fail.  The type of surgery depends on the severity of the condition, ranging from a tendon repair to an ankle reconstruction.  Recovery is prolonged and requires at least 3 months off work depending on your job and 18 months to feel the full benefit of surgery.


It is recommended you reduce any activity that regularly stresses the ankle and tendon (prolonged walking, standing and high impact sport).

Tendon strengthening exercises are prescribed to improve mobility, reduce pain, increase support for the foot/ arch and reduce the risk of re-occurrence.  One of our Physiotherapists, Sports Therapists or Osteopaths can prescribe the right exercises at a level your tendon can cope with so that pain and inflammation does not increase.

All these exercises can be done standing, whilst holding onto a supportive, static surface or sitting in a chair.

Calf raises:

  • Ensure your feet are hip distance apart and toes facing forward.
  • Push up onto the balls of your feet by lifting the heels from the ground over a count of 3 seconds.
  • Slowly lower yourself to the ground over a count of 3 seconds.
  • Repeat 15 times and perform two sets with a 2 minute rest between them.  You can do these in sitting if this exercise is painful in standing.

Surgery may be offered if other treatment options fail.  The type of surgery depends on the severity of the condition, ranging from a tendon repair to an ankle reconstruction.  Recovery is prolonged and requires at least 3 months off work depending on your job and 18 months to feel the full benefit of surgery.

Ball Rolls

  • Place a tennis or golf ball under one of your feet.
  • Maintain a straight spine as you roll the ball under your foot, focusing on the arch.
  • Do this for 2-3 minutes. Then do the opposite foot.

Towel curls

  • Place a towel under your feet
  • Root your heels into the floor as your curl your toes to scrunch up the towel
  • Press your ties into your foot.
  • Hold for a few seconds and release.
  • Make sure to keep the ball of your foot pressed into the floor or towel. – – Maintain an awareness of the arch of your foot being strengthened.
  • Do 2-3 sets of 1-15 repetitions


Diagnosis and clinical findings are initially based on observations.  Sometimes in late stages and where surgery is indicated imaging such as MRI scans may be ordered to confirm the diagnosis and check the extent of the injury.  Blood tests may also be required if a systemic condition is thought to be the cause.

Our Physiotherapists and Osteopath will be able to guide and support you with an exercise programme and also be able to identify any other contributing factors that may influence your recovery.

Helping you live your healthiest and happiest life. Revival Health & Wellbeing Centre offers a variety of treatments, clinics, counselling and holistic therapies from our specialist team of practitioners.

Please contact us on 01386 792 126 to discuss your consultation.