You notice it first on the stairs. A dull ache just behind the bone on the inside of your ankle, the one that sticks out. By the end of a day on your feet it has spread along the arch, and your ankle looks a little puffy when you take your shoes off.
Then one evening you catch your feet in the mirror and something looks off. One arch sits lower than the other. Your heel tips inward. Your favorite walking shoes are wearing down on the inside edge.
You tried resting it. You bought a firmer pair of shoes. A friend told you it was just flat feet and getting older. But flat feet don’t usually show up on one side in your fifties, and they don’t usually hurt.
What sits underneath is a quiet fear: that your foot is changing shape, that it won’t change back, and that the walks through Lithia Park and the summer hikes up toward Mt. Ashland are slipping away.
You shouldn’t have to watch your foot change and be told to wait and see. This pattern has a name, posterior tibial tendon dysfunction (PTTD), and it responds best when it’s caught and loaded properly early.
The Tendon That Holds Up Your Arch
The posterior tibial tendon starts from a muscle deep in your calf, wraps behind the bony knob on the inside of your ankle, and attaches under the arch. Every time you push off, it pulls the arch up and locks the foot into a stiff lever. It’s the main dynamic support of your arch.
PTTD is an overload problem. The tendon has been asked to carry more than it can handle, often for years, and its fibers start to break down where it curves behind the ankle bone and where it attaches to the arch. As it weakens, the arch sags, the heel rolls in, and the tendon is stretched even further. That’s the cycle that turns an ache into a flattening foot.
The usual contributors are a jump in walking, hiking or standing, a foot that already rolls in, a stiff ankle and tight calf that make the foot collapse to find motion, an old ankle sprain, extra body weight, and conditions such as diabetes and high blood pressure that affect tendon health. It’s most common in women over 40.
Here’s why rest and new shoes haven’t been enough. Rest lets the pain settle, but it doesn’t rebuild the tendon. Supportive shoes take some load off, but they don’t make the muscle stronger. A tendon gets its capacity back through the right amount of load, built up on purpose.
Inner ankle pain also has look-alikes. Tarsal tunnel syndrome, a pinched nerve in the same area, burns and tingles rather than aches. A stress fracture or an ankle sprain that never healed can sit in the same spot. The exam sorts these out.
Meet Your Guide
I’m Dr. Noah Volz, a chiropractor in Ashland. Oregon licenses chiropractors as chiropractic physicians, and foot and ankle problems are squarely within what I examine, diagnose and treat. You can see me directly, with no referral.
I see people who have been told their foot is “just flat” while it keeps hurting. My job is to find out how far the tendon has been pushed, then help it get strong enough to hold your arch again. My approach is gentle chiropractic care: less force, more precision.
What I Do When You Come In
- A detailed history: when the pain started, changes in your activity or shoes, old sprains, your health history and what you’ve already tried.
- A hands-on exam: I press along the tendon, look at your arch and heel from behind while you stand, and test the tendon directly with a single-leg heel raise. A tendon that’s struggling shows itself fast in that test.
- Motion and strength testing: ankle, big toe and midfoot mobility, calf flexibility, and hip strength, because a weak hip lets the whole leg roll inward.
- A check for look-alikes: I test the nerves of the foot and screen for stress fracture.
- Imaging when the exam calls for it: if the arch is collapsing quickly or something doesn’t add up, I order an X-ray, ultrasound or MRI.
Then we treat it. I use gentle adjustments and mobilization for a stiff ankle and midfoot so the foot stops collapsing to find motion. Soft-tissue work eases the calf and the muscles along the shin. Kinesiotape supports the arch and calms the tendon while it settles.
The core of the plan is strengthening. I start you on a progressive program for the posterior tibial muscle itself, along with the calf and the small muscles of the foot, and we set the dose so the tendon accepts it, then build week by week. You’ll leave knowing how much walking to do, what to change in your shoes, and which exercises to do at home.
If your tendon problem has stalled despite good rehab, I also offer radial shockwave therapy. When the arch is collapsing fast or a brace or custom orthotic is needed, I co-manage with a podiatrist or foot and ankle specialist, and I keep treating the parts that are mine.
Your Plan in 3 Steps
- Contact Dr. Volz. Send a short note through my contact page and tell me what your foot is keeping you from doing.
- Get examined. A thorough exam of your foot, ankle and leg, imaging if you need it, and a clear diagnosis.
- Follow a plan that fits. Gentle hands-on care and a strengthening program built around your week.
If you’re looking for posterior tibial tendon dysfunction treatment in Ashland, OR, from a chiropractor who gives you a real plan, contact Dr. Volz. I help people from Ashland, Talent, Phoenix, Medford and across the Rogue Valley.
Three Months From Now
Picture walking the Bear Creek Greenway and noticing the trees instead of your ankle. Rising up onto your toes on that foot without wincing. Standing through a long day and taking your shoes off at night to a foot that looks like yours.
Now picture the other path. You keep resting it and waiting, and the tendon keeps losing ground. The arch drops further, your knee and hip start to ache from the new angle, and the conversation shifts from exercises to braces and surgery. PTTD is the kind of problem where early action matters most.
Common Questions
Is PTTD the same as flat feet?
No. Plenty of people have flexible flat feet their whole lives with no pain. PTTD is a tendon that’s failing, and it causes an arch that flattens over time, usually on one side, with pain on the inside of the ankle.
Do I need orthotics?
Arch support helps take load off the tendon while it gets stronger, and some people need a custom orthotic or brace. Support alone doesn’t rebuild the tendon. Strength does, so the exercise program is what I focus on.
Can a chiropractor really help a tendon problem?
Yes. Tendon problems are musculoskeletal problems. I diagnose them, treat the joints and soft tissue around them, and build the loading program that restores the tendon’s capacity. When you need a specialist too, I bring one in.
When I’ll Send You Somewhere Else First
I screen every new patient for these. If you have one, I’ll tell you right away and help you get to the right doctor.
- A sudden pop with immediate weakness, or a suspected fracture after a fall or twist
- A hot, red, swollen foot, especially with fever
- A foot that turns cold, pale or blue, or a painful, swollen calf
- Tendon pain that started soon after taking a fluoroquinolone antibiotic such as ciprofloxacin or levofloxacin; your prescriber needs to know right away
- Fever or unexplained weight loss with foot, ankle or spine pain
Keep Reading
Read about tarsal tunnel syndrome treatment in Ashland, learn about my gentle chiropractic care, or browse everything I treat on my Conditions page.