Best Shoes for Posterior Tibial Tendon Dysfunction (PTTD)
Posterior tibial tendonitis is usually early-stage PTTD, and the stage decides the shoe: control while the foot corrects, room once it cannot. By a DPM.
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On this page
- The short answer
- Why this is a different problem from flat feet
- The four things a shoe has to do, and which are measurable
- What is actually published about these nine shoes
- The finding that should change what you buy
- The shop-floor test, which you can do in ninety seconds
- Which shoe for which stage
- The stage changes the answer, and it changes it completely
- When it is not PTTD
- What footwear cannot do
- Where to buy
- Questions patients ask
- Related guides and reviews
Posterior tibial tendon dysfunction is not the same thing as having flat feet, and that distinction decides the whole shopping list. Flat feet you were born with are usually fine. PTTD is an arch that is collapsing now, in an adult, usually on one side, usually with pain along the inside of the ankle — and the shoe’s job is to stop the heel rolling outward. The two figures that measure whether a shoe can do that are torsional rigidity and heel-counter stiffness, and no brand publishes either. An independent lab has rated both for six of the nine shoes here, and the Brooks Addiction Walker 2, a motion-control walking shoe, scores 3 of 5 on heel counter, softer than a neutral Brooks trainer. That is the kind of thing the label never tells you.
None of these has been under our own caliper, so none is scored and none carries our seal. Every figure below is the brand’s, an independent lab’s, or a named retailer’s, labelled where it sits. What our testing tiers mean →
The short answer
If your deformity is still flexible and you wear a prescribed orthosis, it is the Brooks Beast GTS 26. Brooks states in writing that it is built to accommodate orthotic inserts, on a broad high-volume platform with GuideRails, at a 12 mm drop — and both the Beast GTS 26 and the women’s Ariel GTS 26 are named on APMA’s Brooks listing. $170, in men’s D/2E/4E and women’s B/D/2E.
If you need the most rigid platform here, it is the Brooks Addiction Walker 2. RunRepeat’s lab rated its torsional rigidity 5 of 5, the top of the lab’s older 1-to-5 scale — it barely twists, which is exactly what an unwinding midfoot needs. Its midsole is also the second-firmest of the 33 shoes we review with a lab firmness reading, at 48.7 on the Asker C scale. $140, four widths, leather, 14.5 oz.
If you need a width beyond 4E, it is the New Balance 1540v4. New Balance publishes a 6E on its Made in USA colourways, which no other shoe here offers, with the ROLLBAR post system the brand describes as controlling rear-foot movement. $199.99, and the most expensive thing on this page.
If the deformity has gone rigid, stop shopping for control. A foot that will not correct cannot be corrected by a shoe, and forcing a motion-control shoe onto it causes pain rather than relieving it. What you need then is depth, volume and width — and a conversation with a foot and ankle surgeon.
Where to start
The three situations in the short answer above, with somewhere to check the price. None has been through our bench yet, so there are no scores here.
- A flexible deformity and a prescribed orthosis: Brooks Beast GTS 26Brooks states in writing that it is built to accommodate orthotic inserts, on a broad, high-volume platform with GuideRails. The women’s equivalent is the Ariel GTS 26.Check price, men’s — paid link
- The most rigid platform here: Brooks Addiction Walker 2It barely twists, which is what an unwinding midfoot needs. Leather, in four widths, built for walking rather than running.Check price, men’s — paid link
- A width beyond 4E: New Balance 1540v4New Balance publishes a 6E on its Made in USA colourways. Check the width selector on the listing before ordering.Check price, men’s — paid link
Paid links: we earn a commission at no extra cost to you, and it never changes what is listed. Two more options, and what each cannot do, are further down this page.
Why this is a different problem from flat feet
The posterior tibial tendon runs down the inside of the ankle, behind the bony bump of the medial malleolus, and attaches to the navicular bone in the middle of the arch. It is the main active support of the arch and the muscle that turns the foot inward. Every step you take, it holds the arch up while your weight rolls across it.
When that tendon degenerates and lengthens, nothing holds the arch. The heel drifts outward into valgus, the arch drops, the forefoot swings away from the midline, and over months to years the collapse becomes fixed. The condition has several names in the literature — posterior tibial tendon dysfunction, adult acquired flatfoot deformity, and more recently progressive collapsing foot deformity — and they describe the same process at different stages.
Congenital flat feet are a different thing entirely. A foot that has been flat since childhood has usually adapted to being flat, is often painless, and is usually symmetrical. PTTD is acquired: the arch used to be higher, the change is recent enough to notice, it is typically one-sided, and it hurts along the inside of the ankle rather than under the arch. If you are reading this because one of your feet has gone flatter than the other in the last year or two, you are in the right place. If both your feet have always been flat and the ache is under the arch, start at shoes for flat feet instead.
The four things a shoe has to do, and which are measurable
1. Hold the heel still — heel-counter stiffness
The heel counter is the stiff cup around the back of the shoe. Its job here is to resist the heel bone everting, which is the primary deformity. Squeeze it between finger and thumb: it should barely give. A lab rates it on a 1-to-5 scale, and has rated 35 of the shoes we review, six of them on this page. None here reaches 5; the Gaviota 6, the 860v15 and the GT-2000 15 score 4.
2. Refuse to twist — torsional rigidity
Hold the heel in one hand and the forefoot in the other and wring the shoe like a wet cloth. A shoe for a collapsing midfoot should fight you. This is the figure that corresponds most directly to what PTTD does to a foot. A lab has measured it for 24 of the shoes we review, from 10.3 to 20.5 newton-metres. Five of them are on this page: the Arahi 8 at 19.5 Nm (third-stiffest of the 24), the 860v15 at 18.2, the Gaviota 6 at 17.7, the GT-2000 15 at 14.8 and the Guide 19 at 10.7 (second-least stiff). The Addiction Walker 2 was rated on the lab’s older 1-to-5 scale, at 5 of 5, so it cannot be ranked against these directly.
3. Take the orthosis you were prescribed — volume
Most people with PTTD end up in a custom device, often a deep-heel-cupped orthosis or a UCBL, and those are bulky. A shoe that will not physically hold it is useless no matter how supportive it is. Brooks is the only brand in this group that states in writing that specific models are designed to accommodate orthotic inserts. For everything else, the honest answer is that the insole comes out and you will have to try.
4. Fit a foot that has got wider
A collapsing arch lengthens and broadens the foot, and it does it asymmetrically, so the two feet may no longer take the same size. This is the mundane reason a lot of people in this situation are uncomfortable in shoes that are technically correct for them.
What is actually published about these nine shoes
Sorted by how much support the maker claims, from motion control down to geometry-based stability. Blank cells mean nobody we trust has published that figure.
| Shoe | Support claimed | Drop | Twist / heel counter | Orthotic-friendly | Widths | Price |
|---|---|---|---|---|---|---|
| Brooks Addiction Walker 2 | Motion control — Extended Progressive Diagonal Rollbar Brooks | 12.2 mm RunRepeat lab; Brooks publishes none | 5/5 torsional · 3/5 heel counter RunRepeat lab | Not stated | B, D, 2E, 4E | $140 |
| New Balance 1540v4 | Motion control — ROLLBAR stability post New Balance | 4 mm, stated approximate New Balance | Not published by anyone | Not stated | D, 2E, 4E, 6E on Made in USA | $199.99 |
| New Balance 928v3 | Motion control, walking — ROLLBAR New Balance | Not published | Not published | Not published | B to 6E | $159.99 |
| Brooks Beast GTS 26 | Motion control / maximum support — GuideRails Brooks | 12 mm Brooks | Not published | Yes — stated; APMA Seal, Beast and Ariel both listed | M D/2E/4E · W B/D/2E | $170 |
| HOKA Gaviota 6 | Maximum-cushion stability — H-Frame + MetaRocker HOKA | 6 mm HOKA | 17.7 Nm torsional · 4/5 heel counter RunRepeat lab | Not published | Regular, Wide, X-Wide | $180 |
| New Balance 860v15 | Stability — Stability Plane New Balance | 8 mm Running Warehouse | 18.2 Nm torsional · 4/5 heel counter RunRepeat lab | APMA Accepted badge on both pages | M B/D/2E/4E · W 2A/B/D/2E | $149.99 |
| HOKA Arahi 8 | Stability — H-Frame, dual-density HOKA | 8 mm HOKA | 19.5 Nm torsional · 3/5 heel counter RunRepeat lab | APMA Seal stated on both pages | Regular, Wide, X-Wide | $150 |
| ASICS GT-2000 15 | Stability — 3D Guidance, geometry, no medial post ASICS | 8 mm ASICS | 14.8 Nm torsional · 4/5 heel counter RunRepeat lab | Not published | M D/2E/4E · W 2A/B/D | $150 |
| Saucony Guide 19 | Stability — CenterPath sidewalls, no medial post Saucony | 6 mm Saucony | 10.7 Nm torsional · 3/5 heel counter RunRepeat lab | Not published | Regular, Wide, Extra Wide | $150 |
Lab figures are RunRepeat’s measurements and ratings as recorded in each shoe’s review on this site. Heel counters are rated 1 to 5; torsional rigidity is in newton-metres for the 24 shoes we review that the lab has tested with its current method (10.3 to 20.5 Nm), while the Addiction Walker 2 was rated on its older 1-to-5 scale. Where a brand publishes no drop, the figure is a named retailer’s: Running Warehouse for the 860v15. Brooks and New Balance publish no stack heights at all, and New Balance states its 1540v4 drop figure is approximate because of development variances. Every figure is linked to its source on the review page.
The finding that should change what you buy
Look at the Addiction Walker 2 row again. An independent lab rates it 5 of 5 for torsional rigidity, the top of that scale, and 3 of 5 for heel-counter stiffness.
Three out of five is middling. For comparison, the same lab gave the Brooks Ghost 18 — a neutral cushioned trainer with no support structure at all — a heel-counter score of 5 of 5. So the motion-control walking shoe holds the heel less firmly than the neutral running shoe, which is the opposite of what both labels imply.
That does not make the Addiction Walker 2 the wrong shoe. It is extraordinarily rigid through the middle, which is the part of PTTD that footwear is best placed to resist, and its 48.7 Asker C midsole is the second-firmest of the 33 shoes we review with a lab firmness reading, so it does not let the arch sink into the foam. But it does mean that “motion control” on a box is a marketing category, not a measurement, and that the two shoes you would choose on the label are not necessarily the two that test best on the two properties that matter.
The shop-floor test, which you can do in ninety seconds
- Squeeze the heel counter hard. It should barely deform. If it collapses between two fingers it will not resist a body weight’s worth of heel eversion.
- Wring the shoe out. Hold heel and forefoot and twist. For a collapsing midfoot you want it to fight you — the Addiction Walker 2, at 5 of 5 on the lab’s older scale, is the benchmark here.
- Bend it. It should hinge across the ball of the foot, where your toes hinge, and nowhere else. A shoe that folds in the middle of the arch is actively bad here.
- Put your orthosis in. Not a generic insole — yours. Take the shoe’s own insole out first. If the heel of your device sits proud of the shoe’s heel cup, or your heel now sits too high in the counter, the shoe is the wrong volume for your device.
- Stand on both feet and look in the mirror from behind. The shoe should visibly hold the affected heel straighter than it stands barefoot. If the heel is still rolling out over the edge of the shoe, the shoe is not controlling anything.
- Measure both feet. They are probably not the same any more, and the shoe has to fit the bigger one.
Which shoe for which stage
Brooks Beast GTS 26 — the orthosis wearer’s shoe
The one shoe in this group whose maker says on the record that the design accommodates orthotic inserts, on a deliberately broad high-volume platform, and both the men’s Beast GTS 26 and the women’s Ariel GTS 26 are named on APMA’s Brooks listing — which is rarer than brands’ marketing suggests. Twelve millimetres is the highest drop any brand states here (the Addiction Walker 2 measures 12.2 mm in the lab), which also takes load off the Achilles and the tendon behind it. Heavy, and the heel-counter figure is unpublished.
Brooks Addiction Walker 2 — the most rigid platform here
The only motion-control shoe here with figures to back the label, and they are extreme: it barely twists, and its midsole is the second-firmest of the 33 shoes we review with a lab firmness reading. Leather, four widths, and the cheapest shoe on this page. Two caveats worth holding: the heel counter is only middling at 3 of 5, and at 14.5 oz stated it is the heaviest option, which matters if you are on your feet all day.
New Balance 1540v4 — for a foot wider than 4E
New Balance publishes a 6E on the Made in USA colourways, and nothing else on this page goes past 4E. The ROLLBAR post system is described by the brand as controlling rear-foot movement, which is the right mechanism. Two things to weigh: the 4 mm drop is the lowest in this group, which is the opposite direction from the high-drop shoes usually chosen when the tendon behind the ankle is irritable, and New Balance states the figure is only approximate.
New Balance 928v3 — the walking shoe clinics default to
Motion control in a leather walking shoe with the broadest width range in the business, which is why so many clinics send a wide collapsing foot to it. A strap version is sold separately if laces are difficult. The honest note: New Balance publishes no drop, no weight, no stack and nothing about the insole for this shoe, so almost nothing about it is measurable.
HOKA Gaviota 6 — control plus a rocker
HOKA’s most supportive road shoe, and the only one in this group pairing a support frame with a rocker, which helps if the collapse has also stiffened your midfoot or big toe. Lighter than the motion-control shoes at 10.25 oz. Note that HOKA does not claim the APMA Seal for the Gaviota — its APMA page lists the Clifton, Bondi and Arahi — and publishes no stack height, so the heights here come from a reviewer.
Saucony Guide 19 — and why it is the wrong shoe here
Included as a caution rather than a recommendation. Saucony states plainly that CenterPath works through sidewall guidance and has no medial post, and the GT-2000 15’s 3D Guidance System is likewise geometry rather than a post. Modern “stability” shoes increasingly guide a foot that is already working rather than resist one that is failing. For a mild, early, flexible case that may be plenty. For a heel visibly rolling outward, a guidance sidewall is not the same tool as a post, and the box will not tell you which you are buying.
The stage changes the answer, and it changes it completely
Foot and ankle surgeons stage this condition by whether the deformity still corrects. The classifications have changed names over the years — Johnson and Strom’s stages, Myerson’s addition of a fourth, and more recently the progressive collapsing foot deformity classification — but the practical fork is the same one.
- Tendon irritable, arch still holding. Pain behind the inner ankle, no visible deformity, and you can still do a single-leg heel rise with the heel inverting. This is the stage usually called posterior tibial tendonitis. It is the stage where footwear and an orthosis genuinely alter the course, and also the one people most often ignore because the foot still looks normal.
- Flexible deformity. The arch has dropped and the heel rolls out, but the foot can still be pushed back into position by hand. Control is possible and worth buying: rigid counter, motion control, a prescribed device, sometimes a brace. This is where the shoes above earn their keep.
- Rigid deformity. The foot no longer corrects. A motion-control shoe now fights a joint that cannot move, and that hurts. The aim shifts from correction to accommodation — depth, volume, width, a soft upper and often a custom-moulded device or an AFO. Buying more support at this stage makes things worse, which is the most common footwear mistake in this condition.
- Ankle involved. When the ankle itself tilts into valgus, you are past what any shoe addresses.
Only an examination tells you which of those you are in. The reason it is on this page is that the first two want the opposite shoe from the third, and nothing on a shoe box helps you tell.
When it is not PTTD
- Lifelong flat feet. Symmetrical, longstanding, often painless. See shoes for flat feet and insoles for flat feet.
- Accessory navicular. A bony prominence at the same place the tendon inserts, often painful in adolescence, and it can coexist with tendon trouble. Shoes for accessory navicular syndrome covers it.
- Tarsal tunnel syndrome. Burning, tingling or numbness rather than a deep ache, because the nerve runs alongside the tendon in the same tunnel — and hindfoot valgus can provoke it. See shoes for tarsal tunnel syndrome.
- Sinus tarsi syndrome. Pain on the outside of the hindfoot, which is a classic consequence of the heel rolling out and pinching that space. Shoes for sinus tarsi syndrome.
- Midfoot arthritis. A collapsing arch loads the midfoot joints, and over years they wear. Shoes for midfoot arthritis.
What footwear cannot do
It cannot repair a degenerate tendon. The treatments with the best evidence behind them for early PTTD are an orthosis or brace combined with a progressive strengthening programme — eccentric loading of the tendon, done consistently for months — and for progressive cases, surgery. Footwear is the platform that lets the device work. It is not the treatment, and a shoe bought instead of an assessment costs you the window in which the deformity is still flexible.
And the measurement limit on this page is unusually stark. The two properties that decide whether a shoe can resist a collapsing hindfoot are heel-counter stiffness and torsional rigidity. No brand publishes either, and for three of the nine shoes here, the Beast GTS 26, the 1540v4 and the 928v3, nobody has measured them at all. Everything else in the support column is a brand’s description of its own technology. Those descriptions are not worthless — a post is a real thing and so is a guidance sidewall — but they are claims, not readings, and we have labelled them that way throughout.
Where to buy
Disclosure: the links below are paid links. If you buy through them Amazon pays us a commission at no cost to you. Commissions never influence a score, a ranking or the seal, and nothing on this page is scored because none of these shoes has been tested by us — see our independence policy.
If you have been prescribed a custom device, buy the shoe after you have the device, and take the device to the shop. A shoe chosen first and a device fitted into it afterwards is how people end up with two things that each work and do not work together.
Questions patients ask
What are the best shoes for posterior tibial tendon dysfunction?
If the deformity is still flexible: the Brooks Beast GTS 26 if you wear a prescribed orthosis, because Brooks states it is designed to take one and it is on APMA’s listing; the Brooks Addiction Walker 2 if you want the most rigid platform here, because RunRepeat’s lab rated its torsional rigidity 5 of 5 and its midsole is the second-firmest of the 33 shoes we review with a lab firmness reading; and the New Balance 1540v4 or 928v3 if you need a width beyond 4E. If the deformity has gone rigid, none of those is right and you want accommodation rather than control.
Is PTTD the same as flat feet?
No. Flat feet are a foot shape, often lifelong, usually symmetrical and frequently painless. PTTD is a tendon failing in adulthood, so the arch is collapsing now, usually on one side, usually with pain along the inside of the ankle. The confusion matters because footwear advice for congenital flat feet assumes a foot that has already adapted, and PTTD is a moving target.
Is posterior tibial tendonitis the same as PTTD?
Usually it is the same problem at an earlier stage. Posterior tibial tendonitis is the name most often given when the tendon behind the inner ankle is sore and irritable, but the arch still holds and you can still rise onto the toes of that foot alone. PTTD is the wider term: it covers that stage and the later ones, when the arch drops and the heel rolls outward. The early stage is when footwear and an orthosis change the course most, so it is the one to act on rather than wait out. The staging section above explains how to tell where you are.
Are motion-control shoes good for PTTD?
While the deformity still corrects, yes — resisting heel eversion is the mechanism you want. Once it is rigid, no: a motion-control shoe pushing against a joint that cannot move is a source of pain, not relief. “Motion control” is also a marketing category rather than a measurement, and the one motion-control shoe here the lab has rated, the Addiction Walker 2, scores only 3 of 5 for heel-counter stiffness while a neutral Brooks trainer scores 5 of 5.
Do I need a brace or will shoes do?
That is a question for the clinician examining your foot, and the answer depends on the stage and on how much the tendon still works. What is clear from practice is that footwear is the platform rather than the treatment: an orthosis or brace does the controlling, and the shoe’s job is to hold it in the right place and not twist. If you have been offered a device, the shoe decision comes after it.
Should I look for a high drop or a low drop?
Higher tends to be more comfortable when the tendon behind the ankle is irritable, because raising the heel shortens the whole calf-and-tendon chain. This group runs from 4 mm on the 1540v4 to 12 mm on the Beast GTS 26 and 12.2 mm, lab-measured, on the Addiction Walker 2, so there is a real choice here. Nobody has shown a specific drop figure to be a treatment, so treat it as comfort rather than dose — our heel-to-toe drop chart lists every published figure on the site.
Why does my foot hurt on the outside now when the problem is on the inside?
Because when the heel rolls outward, the space between the heel bone and the ankle bone on the outside of the hindfoot gets pinched. It is a common second act in this condition and it has its own name — see sinus tarsi syndrome. It is usually a sign the hindfoot is not being controlled.
How wide a shoe do I need?
Wider than you did, and possibly a different width on each foot. A collapsing arch spreads the foot, and asymmetrically. Width is a measurement rather than a feeling — how to tell which you are explains how to check, and the shoe width chart lists what each brand offers. New Balance is the only brand here that publishes a 6E.
Related guides and reviews
- Shoes for flat feet · shoes for overpronation · insoles for flat feet — the lifelong version of a flat foot, which wants different things.
- Accessory navicular · tarsal tunnel syndrome · sinus tarsi syndrome · midfoot arthritis — the conditions that travel with it.
- Orthotic Volume Rating — how we measure whether a shoe will actually take your device.
- Shoes for ankle support — when the ankle itself is involved.
- Heel-to-toe drop chart · shoe width chart · stack height chart — every published figure on this site.
- Brooks Beast GTS 26 · Brooks Addiction Walker 2 · New Balance 1540v4 · New Balance 928v3 · HOKA Gaviota 6 · New Balance 860v15 · HOKA Arahi 8 · ASICS GT-2000 15 · Saucony Guide 19
- Shoe spec database — every published number on this site, and who published it.
Recently reviewed
Individual shoe pages state their evidence tier, published measurements and who should skip them.
Saucony Endorphin Speed 5
Spec AnalysisLight plated neutral trainer. Saucony publishes both stack heights and they match its 8 mm drop — not yet tested.
HOKA Mach 6
Spec AnalysisLower, firmer neutral HOKA. HOKA publishes a 5 mm drop and neither stack height — not yet tested.
ASICS Novablast 5
Spec AnalysisBouncy high-stack neutral. ASICS publishes an 8 mm drop and neither stack height — not yet tested.
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