Quick Summary
Inner-ankle pain with a changing arch needs timely assessment. Treatment may combine protection, support and progressive exercise, with specialist input when the foot shape is changing. Our physiotherapists in New Malden can assess your symptoms and help you choose appropriate next steps for your goals.
Understanding Posterior Tibial Tendon Dysfunction
The posterior tibial tendon passes behind the inner ankle and helps support the arch during walking. Pain or dysfunction can be associated with a progressively flattening foot, sometimes called progressive collapsing foot deformity. This differs from longstanding painless flat feet.
Assessment at J&J Therapy
We assess symptom history, walking, foot flexibility and strength. A painful or progressive change in shape may need podiatry or foot and ankle specialist input. Support requirements differ between an early flexible problem and a more established rigid deformity.
Do You Experience These Symptoms?
- Pain or swelling behind the inner ankle and along the arch.
- Difficulty pushing off or performing a controlled single-leg heel raise.
- A newly lower arch or changing foot position, sometimes with outer-ankle pain.
An assessment helps guide your next step, based on your symptoms, health and goals.
Why symptoms may develop
Tendon overload, injury and changes in the supporting tissues can contribute. As the problem progresses, joint alignment and flexibility may change. It should not be treated simply as tight calf muscles, particularly if one foot is becoming flatter.
Treatment and rehabilitation options
Hands-On Manual Therapy
Hands-on care may help associated muscle discomfort or limited movement when appropriate. It cannot restore a damaged tendon or permanently rebuild a collapsed arch. Aggressive treatment over a swollen tendon is avoided. We explain the purpose and check your comfort and response throughout treatment.
Is Shockwave Suitable?
Shockwave is not a routine first-line treatment for posterior tibial tendon dysfunction. Diagnosis, appropriate support and a loading plan take priority, especially when the arch is progressively changing. Your physiotherapist can explain the more suitable options and how their effect will be reviewed during your ongoing rehabilitation.
Targeted Exercise Programme
Exercise may develop posterior tibial and calf strength, balance and walking capacity within tolerance. A suitable insole, brace or temporary protection may be needed after assessment. We coordinate progression with any specialist plan rather than ask you to strengthen through worsening deformity.
When to Seek Urgent Medical Help
While most symptoms are not serious, urgent medical attention is required if you experience any of the following:
- Seek urgent GP or NHS 111 advice for severe pain after injury, inability to bear weight, or a hot swollen joint with fever.
- Go to A&E for an obvious deformity or a foot that becomes cold, pale or numb.
- If you have diabetes and a new foot wound, redness or swelling, contact your GP or diabetic foot team the same day; use NHS 111 if unavailable. Persistent altered sensation also needs medical review.
Your questions answered
Is this just normal flat feet?
No. A new painful or progressively flattening foot is different from a lifelong painless low arch. It deserves assessment because treatment needs can change over time.
Will strengthening lift my arch permanently?
Strengthening can support function in selected cases, but it cannot promise to reverse established deformity. Appropriate footwear, supports and specialist advice may also be important.
Which appointment should I book?
Start with a Physiotherapy Initial Assessment for new, persistent or recurring symptoms. We can assess the problem and agree a plan linked to your daily activities. If you have already had medical care or surgery, bring the relevant instructions.
Book a Physiotherapy Assessment or call our reception team on 07935 869938. Find J&J Therapy at CI Tower, Ground Floor, New Malden.
Related conditions
Flat Feet / Fallen Arches · Tarsal Tunnel Syndrome
Sources and further reading
This page is for general information only and does not replace professional medical advice.
Information updated 15 October 2026. General information only; this page cannot diagnose your symptoms. Treatment is agreed after assessment. For urgent or severe symptoms, use the medical services described above.