Tibialis Posterior Tendinopathy

Tibialis Posterior Tendinopathy affects the foot’s tendon. It causes pain, weakness, and arch problems. Overuse, poor biomechanics, and weak muscles can cause it. Without treatment, it worsens through stages like Flare-up, Tendinosis, and Dysfunction.

Welcome to our comprehensive guide on Tibialis Posterior Tendinopathy, a condition that affects the tibialis posterior tendon in the foot. This resource will provide a detailed overview of this condition, including its symptoms, causes, progression, and various treatment options. Our aim is to equip you with valuable insights to help you understand and effectively manage Tibialis Posterior Tendinopathy.

Understanding Tibialis Posterior Tendinopathy

The tibialis posterior tendon is a crucial component of the heel and ankle, originating deep within the calf and running behind the medial malleolus (inner ankle bone) towards the inner part of the heel. This tendon plays a vital role in maintaining the arch of the foot, preventing excessive flattening (over pronation), and facilitating the foot’s pushing-off motion during activities like running and high-impact exercises.

Identifying Tibialis Posterior Tendinopathy

Tibialis posterior tendinopathy often presents with symptoms similar to those of a chronic rolled ankle. Individuals may experience pain and swelling along the inside of the ankle and arch, following the course of the tendon. To obtain an accurate diagnosis, it is essential to consult a foot expert who can assess your condition thoroughly.

Walking, running, and prolonged periods of standing can exacerbate the pain, and individuals may also notice weakness and discomfort when attempting to rise onto their toes. Additional signs may include arch flattening, outward pointing of the foot, and an inward rolling of the ankle.

Causes of Tibialis Posterior Tendinopathy

Tibialis posterior tendinopathy refers to inflammation or degeneration of the posterior tibial tendon. This condition commonly arises due to overuse or sudden injury, as the tendon undergoes significant stress during daily activities. Several causes contribute to Tibialis Posterior Tendinopathy, including:

  • Overuse or Sudden Injury: Engaging in activities involving a sudden increase in intensity or high impact, such as running, walking, hiking, or climbing stairs, can strain the tendon beyond its capacity.
  • Ankle Sprain or Trauma: Ankle sprains or traumas can inflame the area surrounding the tendon, impairing its proper function.
  • Repetitive Strain due to Poor Biomechanics: Individuals with pronated or flat feet may experience repetitive strain on the tibialis posterior tendon, leading to inflammation and degeneration.
  • Weakness in the Calf Complex and Tibialis Posterior Muscle: Insufficient strength in the calf complex and the tibialis posterior muscle can overload the tendon, increasing the risk of injury.
  • Improper Footwear: Wearing footwear that lacks stability and support can contribute to the development of Tibialis Posterior Tendinopathy.

Progression and Severity of Tibialis Posterior Tendinopathy

Without appropriate treatment, Tibialis Posterior Tendinopathy can progress and become more severe over time. The condition can evolve through the following stages:

  • Tibialis Posterior Flare-up and Tendinopathy: Initial stage characterized by the onset of pain in the tendon following an injury, tear, or overuse.
  • Tibialis Posterior Tendinosis: Chronic stage where the tendon pain persists for over six weeks, leading to degeneration. The tendon becomes weak, slightly lengthened, and consistently painful, surpassing mere inflammation.
  • Tibialis Posterior Dysfunction: Advanced stage where severe damage to the tendon results in notable lengthening and degeneration. At this point, the individual experiences a deficit in strength and is unable to walk without pain or rise onto their toes.

Effective Management Strategies for Tibialis Posterior Tendinopathy

The appropriate treatment for Tibialis Posterior Tendinopathy depends on the severity of symptoms, duration of pain, and tendon functionality. Considering the underlying cause, inflammation, degeneration, strength loss, and potential progression to tibialis posterior tendon dysfunction, the following management strategies are commonly employed:

  • Conservative Treatment Options:
    • Activity Modification: Reducing or avoiding activities that aggravate the condition is crucial for allowing the tendon to heal.
    • Cryotherapy: Applying ice to the affected area can help alleviate pain and reduce swelling.
    • Footwear Adjustment: Wearing appropriate footwear with adequate stability and support can reduce stress on the tendon.
    • Tendon Strengthening Program: Engaging in specific exercises that target the tibialis posterior tendon can promote its recovery and improve strength.
  • Orthotic Intervention:
    • Custom Orthotics: Corrective orthotics designed to reduce tendon stresses, promote healing, and facilitate a return to normal activities may be prescribed.
  • Advanced Treatment Options:
    • Injection Therapy: In cases where pain persists, targeted injection therapy can be administered to reduce pain levels.
    • Bracing or Immobilization: Depending on the severity, a combination of ankle and foot bracing or even immobilisation with a boot may be recommended to allow complete healing of the tendon.
  • Surgical Intervention:
    • Surgical repair is rarely necessary and typically considered a last resort option for severe cases that do not respond to conservative treatments.


Early intervention is crucial in managing Tibialis Posterior Tendinopathy effectively. Consultation with a foot expert can provide an accurate diagnosis and prevent unnecessary pain and restrictions on your lifestyle.

Are you looking for a Melbourne podiatrist to help with your Tibialis Posterior Tendinopathy? Visit Up & Running to learn more about how we can help you today!