Posterior Tibial Tendonitis

What Is Posterior Tibial Tendonitis?

The posterior tibial tendon connects the posterior tibial muscle in the calf to bones on the inner side of the foot and ankle. Its primary role is to support the arch of the foot and help with walking. When this tendon becomes inflamed or injured, the condition is called posterior tibial tendonitis. If the problem persists, the tendon can weaken, leading to posterior tibial tendon dysfunction (PTTD), a progressive condition that may cause the arch to collapse.

Symptoms

Common signs include:

  • Pain and tenderness along the inside of the ankle or arch

  • Swelling along the tendon’s path

  • Weakness when pushing off the foot or standing on tiptoe

  • Difficulty turning the foot inward

  • In advanced cases, a flattened arch and outward turning of the toes or heel

Causes and Risk Factors

Posterior tibial tendonitis often results from overuse or repetitive strain but can also follow an acute injury such as a fall or ankle sprain. Risk factors include:

  • Flat feet or abnormal walking gait

  • High-impact sports or prolonged standing

  • Poor footwear without arch support

  • Obesity or carrying excess weight

  • Inflammatory conditions such as rheumatoid arthritis

Diagnosis

Diagnosis typically involves:

  • Physical examination to assess tenderness, swelling, and foot alignment

  • Imaging tests such as X-rays, ultrasound, or MRI to evaluate tendon damage and rule out other conditions

Treatment Options

Management depends on severity and stage:

  • Early stages: rest, ice, anti-inflammatory medications, supportive footwear, orthotics, and physical therapy

  • Immobilization: walking boots or casts may be used to reduce strain

  • Advanced cases: surgical options such as tendon debridement, tendon transfer, or reconstructive procedures to restore arch support

Outlook

  • Acute tendonitis may resolve within weeks with conservative care.

  • Chronic tendinosis or dysfunction can take months to recover and may require surgery.

  • Untreated cases may progress to adult-acquired flatfoot deformity, causing long-term pain and arthritis.

Prevention

Preventive strategies include:

  • Wearing supportive shoes with proper arch support

  • Avoiding sudden increases in activity intensity

  • Stretching and strengthening foot and calf muscles

  • Maintaining healthy body weight

  • Resting when pain or fatigue develops