What is Tibialis Posterior Tendinopathy?
Tibialis posterior tendinopathy is a condition that affects the tibialis posterior tendon, located along the inside of the ankle. This tendon plays a crucial role in supporting the arch of the foot, stabilising the ankle, and helping you walk and push off efficiently.
When the tendon becomes overloaded, irritated, or weakened, pain develops along the inner ankle and arch. If left untreated, it can lead to progressive flattening of the foot, instability, and difficulty walking.
Early diagnosis and treatment are essential to prevent long-term tendon dysfunction and arch collapse.
Symptoms of Tibialis Posterior Tendinopathy
Common symptoms include:
- Pain along the inside of the ankle, especially during walking or running
- Aching or throbbing pain that worsens with activity
- Swelling or puffiness along the inner ankle
- Tenderness when pressing along the tibialis posterior tendon
- Weakness when attempting to raise the heel or stand on tiptoes
- Flattening of the arch or rolling in of the ankle (overpronation)
- Difficulty walking long distances or on uneven surfaces
Inner Ankle or Arch Pain?
Our podiatrists can accurately diagnose tibialis posterior tendinopathy and create a personalised treatment plan to support your recovery and prevent long-term arch problems.
Common Causes of Tibialis Posterior Tendinopathy
1. Overuse and Repetitive Stress
Activities that involve running, jumping, or prolonged walking can overload the tendon over time.
2. Flat Feet or Overpronation
A collapsing arch places excessive strain on the tibialis posterior tendon, increasing the risk of irritation and weakening.
3. Sudden Increases in Activity
Rapid changes in training intensity, duration, or terrain can overload the tendon before it adapts.
4. Weak Calf or Ankle Muscles
Poor strength and stability in surrounding muscles increase stress on the tibialis posterior tendon.
5. Poor Footwear
Shoes lacking proper arch support or stability can contribute to tendon overuse and discomfort.
6. Previous Ankle Injury
A history of ankle sprains or instability increases tendon workload and risk of tendinopathy.
When to Seek Immediate Medical Attention
Seek urgent care if you experience severe inner-ankle swelling, inability to bear weight, a sudden sharp pain suggesting a tear, or rapid collapse of the arch. People with diabetes or circulation issues should seek prompt assessment for any new foot pain.
How is Tibialis Posterior Tendinopathy Diagnosed?
Your podiatrist may use several methods to diagnose this condition:
- Medical history: Understanding symptoms, activity changes, and footwear
- Physical examination: Checking tendon tenderness, swelling, and arch collapse
- Heel raise test: Identifying weakness when lifting the heel on one foot
- Biomechanical analysis: Evaluating foot posture and gait patterns
- Imaging: Ultrasound or MRI to check tendon thickness, tears, or degeneration
Treatment Options for Tibialis Posterior Tendinopathy
Treatment focuses on reducing pain, restoring strength, and supporting the arch. Early intervention helps prevent the condition from progressing.
Conservative Treatments
- Activity modification: Reducing high-impact activities that worsen symptoms
- Ice therapy: Applying ice to reduce inflammation and discomfort
- Supportive footwear: Using shoes with good arch support and stability
- Custom orthotics: Designed to support the arch and offload the tendon
- Ankle bracing or taping: Providing additional stability during healing
- Stretching exercises: Focusing on calf and Achilles flexibility
- Strengthening exercises: Progressive loading programs targeting tibialis posterior function
- Pain relief medication: Short-term use if needed
Advanced Treatments
- Shockwave therapy: Beneficial for chronic tendinopathy or slow-healing cases
- Guided injections: Used sparingly in select cases to reduce inflammation
- Immobilisation: Use of a boot for moderate to severe tendon irritation
- Surgery: Reserved for tendon tears or advanced cases with significant arch collapse
Preventing Tibialis Posterior Tendinopathy
You can reduce your risk by:
- Wearing supportive footwear with proper arch support
- Strengthening the calf, ankle, and foot muscles
- Avoiding rapid increases in training intensity
- Maintaining good flexibility in the calves and Achilles
- Using orthotics if you have flat feet or overpronation
- Avoiding prolonged walking on uneven surfaces during early rehab
When to See a Podiatrist
Book an appointment if you experience:
- Inner ankle or arch pain lasting more than a few days
- Swelling or tenderness along the tibialis posterior tendon
- Difficulty standing on tiptoes
- Flattening of one or both arches
- Instability or rolling in of the ankle
- Symptoms interfering with walking, running, or daily activity
Frequently Asked Questions
Mild cases may improve in 4–6 weeks with early treatment, while chronic or advanced cases can take several months. Consistent strengthening and proper footwear are key to recovery.
High-impact activities may need to be reduced temporarily. Low-impact exercises such as cycling or swimming are often suitable. A podiatrist can guide safe training adjustments.
Custom orthotics are highly effective for people with flat feet, overpronation, or arch collapse as they reduce stress on the tibialis posterior tendon and support proper alignment.
References
- Australian Podiatry Association. (2023). Tendon Disorders of the Foot and Ankle.
- Menz, H. B., et al. (2021). Tibialis posterior dysfunction and biomechanics. Journal of Foot and Ankle Research.
- Healthdirect Australia. (2024). Foot pain and tendon injuries.
