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Posterior tibial tendon dysfunction (PTTD) is the term used when the tibialis posterior tendon is unable to perform its usual function. This most commonly occurs due to an injury with subsequent inflammation and/or overstretching of the posterior tibial tendon in the foot. The posterior tibial tendon is a fibrous cord that extends distally from the tibialis posterior muscle in the leg. It descends down the leg and runs along the inside of the ankle, down the side of the foot and into the arch.