The tibialis posterior tendon is located on the inside of your ankle and connects the tibialis posterior muscle (located deep in your calf) to the bottom of the arch of your foot. Its primary functions are to support the side-to-side movement of your ankle and the arch of your foot.
When it is injured, it usually causes pain on the inside of your ankle. It will be tender to touch and aggravated by activities that put weight on your foot. As it supports the arch of your foot, it is common to develop a lower arch of flat foot. Often your foot will rotate outwards while standing and walking, especially if your calf is tight. Due to biomechanical changes, it is common to see other conditions develop due to this injury such as Achilles tendinopathy, and knee and hip pain.
It is an injury due to overuse and overload of the tendon. Therefore, the first step to address your pain is to identify factors that have led to overload of the tendon and adjust them as much as possible. This can include things like activity modification, arch support, and footwear changes. The second step is to build the strength in the tendon, stimulating it to heal and protecting if from future overload. Early conservative intervention that includes exercise has been shown to be more successful in this condition.
DISCLAIMER: This information is not intended as medical advice or a substitute for medical counseling. By choosing to follow the information that follows, you recognize that despite all precautions taken by Physio Fixes Inc. there is a potential risk of injury and you expressly acknowledge such risks and waive, relinquish, and release any claim that you may have against Physio Fixes Inc. You should always get evaluated for exercise by a physician or medical professionals, especially if symptoms occur from a trauma or are worsening. The user agrees by purchasing this program that Physio Fixes will not be held responsible in the event that an injury occurs.
References
Kohls-Gatzoulis J, Angel J C, Singh D, Haddad F, Livingstone J, Berry G et al. Tibialis posterior dysfunction: a common and treatable cause of adult acquired flatfoot BMJ 2004; 329 :1328 doi:10.1136/bmj.329.7478.1328
Kornelia Kulig, Stephen F Reischl, Amy B Pomrantz, Judith M Burnfield, Susan Mais-Requejo, David B Thordarson, Ronald W Smith, Nonsurgical Management of Posterior Tibial Tendon Dysfunction With Orthoses and Resistive Exercise: A Randomized Controlled Trial, Physical Therapy, Volume 89, Issue 1, 1 January 2009, Pages 26–37, https://doi.org/10.2522/ptj.20070242
Kulig K, Lederhaus ES, Reischl S, Arya S, Bashford G. Effect of eccentric exercise program for early tibialis posterior tendinopathy. Foot Ankle Int. 2009 Sep;30(9):877-85. doi: 10.3113/FAI.2009.0877. PMID: 19755073.
Milani, C., Vyas, K. & Malik, G. Evidence-Based Diagnosis and Treatments of Posterior Tibialis Tendinopathy. Curr Phys Med Rehabil Rep 10, 273–281 (2022). https://doi.org/10.1007/s40141-022-00366-3
Ross MH, Smith MD, Mellor R, Vicenzino B. Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines. BMJ Open Sport Exerc Med. 2018 Sep 19;4(1):e000430. doi: 10.1136/bmjsem-2018-000430. PMID: 30271611; PMCID: PMC6157513.
