Adult-acquired flatfoot doesn't happen overnight — the posterior tibial tendon fails in stages, and each stage has an intervention. A posterior tibial tendonitis (PTTD) poster shows the staging system that drives every treatment decision.
The stages that decide treatment
- Stage I–IV: from tenosynovitis with normal alignment to rigid arthritic collapse — the poster's core teaching.
- The too-many-toes sign: the visual clue patients can check themselves.
- Conservative ladder: bracing (Arizona/gauntlet), orthotics, PT, and activity modification — matched to stage.
- Surgical reconstruction: tendon transfer, osteotomy, and fusion — the stage-appropriate operations.
Staging is the treatment
PTTD care is entirely stage-driven, and patients who understand their stage accept the prescribed intensity — bracing instead of "just orthotics," surgery instead of endless bracing.
Part of our sports medicine, tendon & heel pain collection.
Placement
Exam rooms where flatfoot is evaluated. Three sizes, printed on demand.