Tibialis Posterior Tendinopathy: Understanding Foot Problems and Treating The Pain
Blog Health News 17th March 2025
Don’t put up with foot pain, consult a doctor today.
The ins and outs of tibialis posterior tendinopathy, answering common questions to help you better understand the condition, its causes, symptoms, diagnosis and treatment options.
What is Tibialis Posterior Tendinopathy?
Tibialis posterior tendinopathy is a condition that affects one of the most important tendons in the lower leg. The tendon is responsible for helping with foot inversion, supporting the arch of the foot, and assisting in walking, running, and standing. This tendon plays a crucial role in foot function, and when it becomes injured or inflamed, it can cause significant discomfort and impair mobility.
The tendon suffers from repetitive stress or micro-tears, which can lead to pain, swelling, and difficulty with normal movement. This condition is often associated with overuse, but it can also result from other factors, such as age or underlying foot structure issues.
What are the possible causes?
There are several factors that can contribute to the development of tibialis posterior tendinopathy, including:
- Repetitive Strain or Overuse: Engaging in activities that involve repetitive foot motion, such as running, hiking, or sports involving jumping, can stress the tibialis posterior tendon over time.
- Flat Feet (Pes Planus): People with flat feet or fallen arches are at an increased risk for tibialis posterior tendinopathy. The abnormal foot mechanics associated with flat feet can place extra strain on the tendon, leading to injury.
- Age: Tendons naturally lose flexibility and strength as we age. As a result, older adults are more susceptible to tendinopathy due to reduced tissue elasticity and healing capacity.
- Obesity: Carrying excess weight places more stress on the lower extremities, including the tibialis posterior tendon, increasing the likelihood of injury or degeneration.
- Sudden changes in activity level: A sudden increase in activity intensity or frequency, such as increasing running distance or beginning a new sport, can overload the tendon and lead to tendinopathy.
- Inappropriate footwear: Wearing shoes that do not provide adequate support or cushioning can contribute to abnormal foot mechanics and increase the risk of tendon strain.
- Previous injury: If you’ve experienced an earlier injury to the tendon or ankle, you may be more prone to developing tendinopathy due to altered movement patterns or weakened tendon tissue.
What are the symptoms?
The symptoms of tibialis posterior tendinopathy can vary in severity, but common signs include:
- Pain and tenderness: Pain is typically felt along the inside of the ankle, around the area where the tibialis posterior tendon runs. The pain can start as mild and progressively worsen with activity.
- Swelling: Swelling around the tendon can occur, particularly in the initial stages of tendinopathy, often causing discomfort and stiffness.
- Difficulty walking or running: As the condition progresses, it may become more challenging to walk, run, or engage in any activity that requires pushing off with the foot. The pain may worsen with weight-bearing activities.
- Flat foot deformity: In more severe cases, the condition can lead to a flattening of the arch of the foot, as the tibialis posterior tendon plays a crucial role in maintaining the arch. This is often associated with chronic tendinopathy.
- Weakness: A sense of weakness or instability in the foot and ankle is common, especially when attempting to perform movements like standing on tiptoe or pushing off during walking or running.
How are foot problems diagnosed?
If you suspect you have tibialis posterior tendinopathy, it’s important to seek professional medical advice. A healthcare provider, such as a podiatrist, orthopedic specialist, or physical therapist, will begin by performing a physical examination. They will assess:
- Range of motion: The physician will check for limitations in movement, particularly in foot inversion or pushing off.
- Tenderness: The doctor will apply pressure along the tendon to check for pain or swelling.
- Foot structure: A check for signs of flat feet, fallen arches, or other structural issues may be performed.
- Strength testing: The provider may assess the strength of the tibialis posterior tendon by having the patient attempt certain movements like standing on tiptoe.
In addition to a physical exam, diagnostic imaging may be used to confirm the diagnosis or rule out other conditions:
- X-rays: Can help assess bone structure and identify any bony abnormalities, but they will not show soft tissue damage.
- MRI: A more detailed scan that can provide a clear image of the tendon and surrounding structures, showing inflammation, tears, or degeneration.
- Ultrasound: Sometimes used to assess tendon thickness and integrity in real-time.
What are the treatment options?
Treatment for tibialis posterior tendinopathy typically includes the following options:
- Rest and activity modification: The first step is often to reduce activity levels to avoid further stress on the tendon. Low-impact activities like swimming or cycling may be substituted temporarily.
- Ice and elevation: Applying ice to the affected area can help reduce inflammation and swelling. Elevating the foot when resting can also assist in managing swelling.
- Physical therapy: A structured rehabilitation program can help restore strength and flexibility to the tendon, as well as correct any abnormal movement patterns. This may include stretching exercises, strengthening exercises, and proprioception training to improve balance and stability.
- Orthotics or footwear modifications: Custom-made orthotics or supportive shoes may be recommended to correct any foot alignment issues, such as flat feet, and provide additional support for the arch.
- Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help alleviate pain and reduce inflammation during the early stages of treatment.
- Corticosteroid injections: In cases of severe pain or inflammation, corticosteroid injections may be used to provide relief. However, these are usually reserved for more advanced cases due to potential long-term effects on tendon health.
- Surgery: If conservative treatments fail to provide relief after several months, surgical intervention may be considered. This could involve tendon repair, tendon transfer, or even a tendon lengthening procedure to restore function.
How can we help?
At our clinic, we specialise in diagnosing and treating conditions like tibialis posterior tendinopathy. Our approach combines expert clinical assessment with personalised treatment plans to address your specific needs.
- Comprehensive evaluation: We conduct a thorough assessment of your foot mechanics, gait, and activity patterns to identify any contributing factors.
- Physical therapy programs: Our experienced physical therapists will design a rehabilitation program to strengthen the tibialis posterior tendon, restore your range of motion, and prevent future injury.
- Custom orthotics: We offer custom orthotic solutions tailored to your foot structure, providing the support necessary to relieve stress on the tendon.
- Collaborative care: Our team works closely with specialists to ensure the most effective treatment, whether it’s through advanced imaging, injections, or surgery if necessary.
In conclusion, tibialis posterior tendinopathy is a manageable condition when addressed early and with the right treatment. Whether you’re an athlete or simply someone experiencing discomfort, seeking professional help can make a significant difference in your recovery and long-term foot health.
Schedule an appointment with us today to begin your journey toward recovery.
Article produced by:
Sevenoaks Medical Centre
