Common foot & ankle concerns we treat
- Pain that limits walking, standing, or sleep
- Stiffness, swelling, or reduced range of motion
- Sports injuries: acute or overuse
- Arthritis or post-traumatic joint changes
- Conditions other doctors couldn’t resolve
Foot & Ankle · Conditions A to Z
Adult Acquired Flatfoot (PTTD) collapsing arch
Adult acquired flatfoot, also called posterior tibial tendon dysfunction (PTTD), is a progressive collapse of the foot's arch in adulthood, usually as the tendon that holds the arch up weakens and stretches over time. We offer same-day or next-day evaluations across eight LA-area offices.
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Board-certified surgeons and podiatrists across eight Los Angeles area neighborhoods.
Book a visitOr call (323) 264-7600
What sets LAOSS apart
- Same- or next-day appointments at eight Los Angeles-area offices
- On-site imaging; PT coordinated with your in-network provider
- Conservative-first care, surgery only when needed
- Board-certified specialists, not generalists
Key takeaways
- Adult acquired flatfoot is a gradual collapse of the arch, most often caused by wear and weakening of the posterior tibial tendon (PTTD).
- Caught early, most patients improve with bracing, custom orthotics, immobilization, and targeted physical therapy, no surgery needed.
- Left untreated it tends to progress from a flexible, correctable deformity to a stiff, arthritic one, so early evaluation matters.
- On-site imaging at most offices and same-day appointments across eight Los Angeles-area locations.
Overview
What is adult acquired flatfoot (pttd)?
Adult acquired flatfoot describes an arch that gradually flattens during adulthood. The most common cause is posterior tibial tendon dysfunction (PTTD): the posterior tibial tendon runs behind the inner ankle bone and acts as the main support for your arch. When that tendon becomes inflamed, frayed, or stretched out, the arch slowly loses its support and the heel drifts outward.
Unlike flat feet you've had since childhood, this is a change from how your foot used to look and feel, often starting with pain and swelling along the inside of the ankle, then a visibly lower arch. Because the deformity tends to progress from flexible to rigid over time, early, conservative care gives you the best chance of staying out of the operating room.
Below we walk through the anatomy involved, the symptoms and causes we see most often, how we stage and diagnose PTTD, and the full range of treatment options, from bracing and orthotics to tendon transfer and reconstruction.
Patient education
Watch: Adult Acquired Flatfoot
This is a collapse of your foot's arch. It happens over time, usually in just one foot but sometimes in both. As your arch collapses, the bones of your foot may gradually shift out of alignment. This can cause pain and other problems.
Anatomy
Inside the foot & ankle.
The foot and ankle have 26 bones, more than 30 joints, and over 100 ligaments and tendons. The plantar fascia spans the bottom of the foot, the Achilles tendon anchors the calf to the heel, and the ankle is a hinge that handles every step you take. Most foot and ankle problems trace back to overload, alignment, or footwear that doesn’t match the way your foot is built.
Self-orient
When adult acquired flatfoot (pttd) shows up.
Symptoms
Common symptoms
- Pain and swelling along the inside of the ankle and arch, following the posterior tibial tendon
- A gradually flattening arch and a heel that tilts outward
- Difficulty or pain standing on tiptoe, especially a single-leg heel raise
- A "too many toes" appearance when viewed from behind
- Pain on the outside of the ankle in later stages as the heel bone impinges
- Tiredness or aching in the foot after standing or walking
Causes
Common causes
- Degeneration and overuse of the posterior tibial tendon (the leading cause)
- Age, obesity, diabetes, and high blood pressure, which raise the risk
- A pre-existing flexible flat foot that overloads the tendon
- Prior ankle injury, sprain, or fracture affecting hindfoot alignment
- Inflammatory arthritis such as rheumatoid arthritis
- Repetitive high-impact activity over many years
Diagnostics
How we diagnose adult acquired flatfoot (pttd)
You want answers, fast, and we’re built to give them. Most patients leave their first LAOSS visit with a clear diagnosis and a written plan, not another referral chain.
Here’s what your initial visit for adult acquired flatfoot (pttd) typically looks like:
- Detailed history: when it started, what makes it better or worse, what you’ve already tried
- Focused exam of the foot & ankle: range of motion, stability, strength, specific provocation tests
- On-site imaging at most offices: X-ray for bone, ultrasound or MRI when soft-tissue detail is needed
- A written plan with options ranging from conservative care to surgical procedures, in plain English
Schedule your evaluation with a trusted Greater Los Angeles orthopedic expert today.
Treatment options
How we treat adult acquired flatfoot (pttd) at LAOSS
Once we’ve confirmed the diagnosis, the next step is matching the right treatment to your situation. We start with the least-invasive option that fits, and escalate only when it doesn’t.
Conservative care
Step 1Conservative care first
Non-surgical options designed to relieve pain, restore movement, and avoid the OR when possible.
- Walking boot or short-leg cast to rest an acutely inflamed tendon
- Custom orthotics with medial arch support and heel posting
- Ankle-foot orthosis (AFO) or lace-up brace for more advanced cases
- Physical therapy with eccentric posterior tibial strengthening and calf stretching
- NSAIDs and activity modification to calm inflammation
- Weight management and supportive, stable footwear
Surgical care
When neededSurgical options when needed
Procedures performed by board-certified foot & ankle surgeons when conservative care isn’t enough.
- Tendon debridement and synovectomy for early, persistent tendinitis
- Flexor digitorum longus (FDL) tendon transfer to restore arch support
- Medializing calcaneal osteotomy to realign the heel
- Lateral column lengthening or Cotton osteotomy to rebuild the arch
- Spring ligament repair or reconstruction
- Hindfoot or triple arthrodesis (fusion) for a rigid, arthritic deformity
Surgeon expertise
Why experience matters.
Why experience matters
Foot & Ankle care is highly technique-dependent. Volume, training, and judgment together determine the outcome you actually feel six months later.
- Precise diagnosis from imaging and exam
- Conservative-first care that avoids unnecessary surgery
- Surgical technique refined over thousands of cases
- On-site imaging + coordinated PT through your in-network provider
The LAOSS approach
Our foot & ankle specialists move stepwise: start with the least-invasive option that fits your situation, escalate only when it doesn't.
- Same-day imaging at most offices
- PT coordinated in your insurance network
- Board-certified surgeons performing the procedures themselves
- Direct access to your specialist between visits
Candidacy
Am I a candidate?
If most of these match your situation, an evaluation with a foot & ankle specialist is the next step.
You may be a candidate if
These signs typically point toward an in-person evaluation with a foot & ankle specialist.
- A noticeable change in your arch height or foot shape compared with years past
- Pain and swelling along the inside of the ankle that hasn't settled
- Trouble rising onto your toes or doing a single-leg heel raise
- Worn-out shoes that tilt inward, or a heel that looks tilted from behind
- New pain on the outer side of the ankle as the deformity progresses
What evaluation includes
Your first visit is built to give you an answer the same day, not just another referral.
- Detailed history: onset, mechanism, what makes it better or worse
- Hands-on exam focused on the affected joint or region
- On-site imaging at most offices (X-ray, ultrasound)
- Clear plan with options ranging from conservative to surgical
- Same-day or next-day scheduling for any follow-up tests
ImportantSeek urgent evaluation for sudden severe pain, an open wound or exposed bone, foot or ankle deformity after trauma, loss of sensation, or any sign of infection (fever, spreading redness, or swelling).
Recovery
Your foot & ankle recovery roadmap.
Recovery is rarely a straight line, but a clear plan with measurable milestones makes the path predictable.
01Days 0 to 14
Right after care
In the first two weeks we focus on protecting the foot & ankle, calming inflammation, and restoring basic motion.
- Activity modification with clear do/don’t guidance
- Ice, elevation, and pain control as needed
- Gentle range-of-motion within safe limits
- Follow-up scheduled to track healing
02Weeks 2 to 8
Rehabilitation
Targeted physical therapy rebuilds strength, mobility, and confidence in the foot & ankle.
- Progressive strengthening and neuromuscular work
- Manual therapy and soft-tissue treatment
- Sport- or job-specific movement re-training
- Coordinated PT through your in-network provider
03Months 2+
Long-term care
Once function is restored, the focus shifts to keeping you there, and catching any recurrence early.
- Return-to-activity plan with measured benchmarks
- Home program tailored to your sport or job
- Maintenance visits or imaging if symptoms change
- Direct line back to your specialist if needed
Risks & considerations
What to weigh before you decide.
We talk through the risks and benefits with every patient. Informed consent is a conversation, not a form.
General considerations
Every orthopedic intervention carries a small set of standard risks. We screen, prepare, and monitor for these on every patient.
- Infection (rare with modern technique and prophylaxis)
- Bleeding or bruising at the treatment site
- Reaction to anesthesia or medications
- Need for additional procedures in some cases
Foot & Ankle-specific considerations
Some risks are tied to the structures we're treating in the foot & ankle. We discuss these in detail at your visit so you can weigh them against the benefits.
- Temporary stiffness or weakness during recovery
- Incomplete pain relief in a small percentage of cases
- Nerve or vessel irritation near the treatment area
- Need for follow-up therapy to fully restore function
Your care team
Meet our foot & ankle doctors in the Greater Los Angeles area
At LAOSS, our foot & ankle specialists combine advanced surgical expertise with a patient-first approach. From minimally invasive arthroscopic techniques to reconstruction, fracture care, and arthritis management, our physicians bring decades of experience to every case. Trusted across Los Angeles, our team is dedicated to restoring mobility, relieving pain, and helping you return to the activities you love.
About this care
Reliable adult acquired flatfoot (PTTD) care starts here
Adult acquired flatfoot rarely fixes itself, but it also rarely needs to be rushed into surgery, especially when it's caught early. At LAOSS, our foot & ankle specialists stage your condition carefully and start with the least-invasive plan that fits, from custom bracing and orthotics to coordinated physical therapy with your in-network provider. With same- or next-day appointments at multiple Los Angeles locations and on-site imaging at most offices, you won't wait weeks for an answer.
If reconstruction is the right call, our board-certified surgeons perform the procedure themselves and walk you through every step, recovery timeline, and return-to-activity milestone. Call or schedule online today to begin with a trusted foot & ankle specialist in Los Angeles.
FAQ
Common adult acquired flatfoot (pttd) questions
- We start with a focused exam: checking your arch, heel alignment, the "too many toes" sign, and your ability to do a single-leg heel raise. Weight-bearing X-rays are usually done in-office, and we add MRI or ultrasound when we need to see the posterior tibial tendon in detail and confirm the stage.
Ready when you are
Don’t wait on pain.
Book a visit with a foot & ankle specialist at any of our eight Los Angeles-area offices.
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Greater Los Angeles
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