Signs and Treatment of Posterior Tibial Tendonitis


Posterior tibial tendinitis is a common problem. It occurs when one of the tendons on the inside of the ankle is damaged, which can lead to other problems.

This article explains what this condition is, how it occurs, the symptoms to look out for, and how to treat them.

Get Medical Information / Cindy Chang

Ankle anatomy

A review of your anatomy will help you understand how this happens. The tibialis posterior muscle attaches to the back of the tibia. The posterior tibial tendon connects this muscle with the bones of the foot. A tendon is a thick cord of tissue that connects muscle to bone.

The posterior tibial tendon runs along the back of the leg, near the Achilles tendon. Then roll under the inside of the ankle. Here it adheres to the bone on the inside of the foot, next to the arch of the foot.

Problems with the posterior tibial tendon usually occur just below the inner side of the ankle called the medial malleolus . The medial malleolus is the end of the tibia (tibia). This is a large lump that you feel on the inside of your ankle. The posterior tibial tendon wraps just below the medial malleolus.

This area of the tendon is especially prone to problems: it is in the " basin " that the blood supply is weakest. Therefore, when a tendon is damaged due to injury or overuse , the body has trouble providing the nutrients necessary for healing.

Symptoms of posterior tibial tendonitis

Very often, people with posterior tibial tendonitis experience pain on the inside of the foot and ankle. Sometimes they may have an unsteady gait or trouble maintaining stability while walking.

Many people with this condition report a recent ankle sprain . However, some had no recent injuries. The tendon can also be damaged by overuse.

As the condition worsens, the arch of the foot may flatten and the toes begin to point outward. This is because the posterior tibial tendon does not fulfill its function of supporting the arch of the foot.

Adult flat feet

If left untreated, posterior tibial tendonitis can gradually cause a problem called adult acquired flatfoot deformity (AAFD), also known as a drooping arch . This condition usually begins with pain and weakness in the tendon.

As AAFD progresses, the ligaments of the foot are affected. At this point, the foot joints may no longer be properly aligned and may be in the wrong position. For this reason, most doctors prefer early treatment to later stages of AAFD.


Symptoms of posterior tibial tendonitis include:

  • Pain on the inside of the foot and ankle.
  • Unsteadiness when walking
  • Flattened arch
  • Fingers begin to point out


Doctors diagnose posterior tibial tendonitis through a physical exam. People with this condition have tenderness and swelling along the posterior tibial tendon.

They also usually have weakness when trying to push their toes inward. They also find it difficult to stand on tiptoe on the affected side.

If the test results are unclear or your doctor is considering surgery, he or she may order an MRI . An MRI scan can determine if and where a tendon has ruptured. It can also indicate inflammation around the tendon.


Posterior tibial tendinitis is classified according to the stage of the disease. Stages 1 to 4 indicate an increasing deformity (irregular shape) of the foot as the condition progresses:

  • Stage 1 : The earliest stage is pain and swelling along the tendon. The foot may appear completely normal. On the other hand, some people may notice that their foot has a slight flatfoot deformity. Perhaps it seems to you that it has always been this way.
  • Stage 2 : As the disease progresses, the arch of the foot begins to collapse. When they stand up, the foot feels flat on the inside. At this stage, it may be possible to correct the flattened arch.
  • Stage 3 : In stage 3 of a condition called rigid flat foot deformity, the doctor cannot easily correct the foot.
  • Stage 4 : In stage 4, not only the foot is affected, but also the adjacent ankle joint .

As these stages progress, more extensive treatments are required to correct the problem.

Non-surgical treatment can be applied at any stage. However, the chances of success with these options decrease as the condition progresses.

Watch out

Treatment varies depending on the stage of tendonitis. In the early stages, it is mostly rest. Later operation may be required.

Early treatment

The initial treatment for posterior tibial tendonitis is rest so that the tendon can heal. Unfortunately, even walking normally can interfere with proper tendon healing. In these cases, you should stop using your ankle to give it rest.

Early treatment options include:

By providing a rigid platform for the foot, the shoe inserts and walking boots prevent movement between the midfoot and the back of the foot. Prevention of this movement should reduce the inflammation associated with posterior tibial tendonitis.

The discs are more annoying. But they are probably the safest method of ensuring adequate tendon rest. Anti-inflammatory medications and limited mobility can help control inflammation around the tendon.

Physical therapy , which includes stretching and strengthening exercises, can also help relieve pain and help you return to normal activities.

Surgical options

Surgical management of posterior tibial tendonitis is controversial. Surgical options vary depending on the severity of the disease and include:

  • Wound removal : At an early stage, some surgeons may recommend a procedure to remove inflammation. During surgical debridement, inflamed tissue and abnormal tendon are removed. This allows the damaged tendon to heal.
  • Reconstruction : In later stages, the arch of the foot collapses. At this point, simply treating the tendon may not be enough to correct the problem, and your doctor may instead reconstruct the area with surgery. This involves the use of an adjacent tendon called the flexor digitorum longus to replace the damaged posterior tibial tendon. The bones of the foot can also be cut and reshaped to create a new arch.
  • Fusion : Finally, in more advanced cases where the arch of the foot has become stiff, doctors often prefer a fusion procedure in which the bones and joints of the foot are fixed in place to repair the arch.


Treatment options depend on the stage of the posterior tibial tendonitis.

In the early stages, you can heal the tendon by resting your foot and ankle.

As the condition progresses, you will most likely need surgery. Wound removal, reconstruction, and fusion are surgeries used for posterior tibial tendonitis. Which surgery is best for you will depend on the severity of your condition.


Posterior tibial tendinitis is a condition in which pain occurs on the inside of the foot and ankle. This can cause unsteadiness when walking.

Over time, this condition can lead to flattening of the arches, a condition called adult acquired flatfoot deformity (AAFD).

The diagnosis is made on the basis of a physical examination. Sometimes MRI can be used. The condition is divided into stages (1-4) based on severity.

Treatment depends on how far away the condition is. In the early stages, it is treated with immobilization and rest. In the later stages, surgery is required.

Get the word of drug information

Posterior tibial tendinitis and flatfoot acquired in adults can be uncomfortable. Often times, people feel uncomfortable and instability is ignored by a physician who may not be aware of the problem.

However, it is best to treat the condition early before it worsens. Therefore, it is important to find a doctor who will listen to you and take your symptoms seriously.

In the later stages, surgery is usually required and you may lose some of the function of the foot. For these reasons, early treatment, such as wearing a cast, shoe, or brace, and physical therapy are important.

Frequently asked questions

  • Yes. These include exercises to improve range of motion, balance, and proprioception, and to strengthen the ankle, foot, knee, and hip. Before doing any exercise to treat TCH, talk with your doctor to find out which exercise is best for you.

  • Risks include heavy bleeding, blood clots, nerve damage, infection, weak calf muscles, complications from anesthesia, and ongoing foot or ankle pain. However, they may differ based on your age, general health, type of surgery, and foot anatomy.

  • The first stage of posterior tibial tendonitis involves swelling of the tendon on the inside of the ankle. There are times when the foot may appear normal or may include a slight flatfoot deformity. If you are concerned about the health of the inner ankle, it is recommended that you consult your doctor.

  • The bone inside the ankle is called the medial malleolus . It is a large, bony bump located at the end of the tibia.

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