Tibialis posterior tendinopathy causes inner ankle and foot pain, progressive foot flattening, and can make it difficult to stand up on your toes.
Your posterior tibial tendon is a crucial tendon when it comes to healthy foot and leg function, supporting the structure of your foot and arch as well as facilitating optimal and pain-free movement every time you take a step. The posterior tibial tendon originates at the back of the calf muscle, travelling down the side of our lower leg, crossing the inside of our ankle, and attaching to the underside of the foot. When the tendon is damaged or irritated, this is known as tibialis posterior tendinopathy, or more commonly posterior tibial tendon dysfunction (PTTD).
You may suspect that your posterior tibial tendon has been damaged if you’re experiencing pain along the inside of your foot or ankle (with or without swelling) that worsens with physical activity. A common exercise we ask you to do in our clinic to assess the severity of your tendon dysfunction is called a single raise heel test. To perform the test, hold onto the wall or a chair, beginning in a standing position and lift the unaffected foot up off the ground. Now, attempt to lift onto the toes of the affected foot. If you find this difficult or painful, it’s time to book in with your podiatrist.
The symptoms of posterior tibial tendon dysfunction progressively worsen, and as such, it is characterised into four stages of progression:
PTTD is an overuse condition, meaning that it is caused by repetitively overloading and straining the tendon past what it can safely handle, resulting in damage, inflammation and ultimately the inability of the tendon to carry out its role. Contributing factors to the development of PTTD can include:
We often see tibialis posterior tendinopathy in older adults, middle-aged women, and young athletes. In older women, this is linked to age-related changes in their collagen structure, which leads to reduced support and reinforcement in the arch, which can lead to a flatter foot and greater strain on the posterior tibial tendon.
Before you get in to see your podiatrist, there are several things you can do to ease your foot and ankle pain:
All of the above suggestions are designed to help give you relief from your pain, but it’s important to note that they are not designed to ‘fix’ the problem. Fixing the problem means understanding why your posterior tibial tendon has become damaged and overloaded, and addressing these causes so that they don’t continue to worsen and cause you pain. Our in-depth knowledge in these fields is why our team is trusted to care for feet affected by posterior tibial tendon dysfunction, and how we produce results that last.
Here at Matt Raden Podiatry, our trusted and experienced podiatrists treat posterior tibial tendinopathy regularly, utilising a range of evidence-based and proven methods combined with getting to know your goals, your lifestyle and your preferences.
Every appointment starts with a biomechanical assessment to uncover the true causes of your problem in a structured and measurable way. Your assessment involves a physical exam, testing the range of motion at your joints and the strength in your feet and legs, assessing your foot posture, and performing a video gait analysis. If we suspect you may have a partial tear in your posterior tibial tendon, we’ll refer you for medical imaging. Your treatment with us may involve:
In very severe cases of posterior tibial tendon dysfunction, a referral to explore surgical options may be necessary.
If you’ve damaged your posterior tibial tendon or are experiencing pain on the inside of your ankle, our team is here to help - and to ensure you have the best experience doing so. We’re proud to go above and beyond for our patients, focusing not only on treating your pain and injury, but helping prevent it from recurring in the future.