Tibialis Posterior Tendinopathy

Tibialis Posterior Tendinopathy


Article by Zoe Russell


Tibialis Posterior Tendinopathy

What is Tibialis Posterior Tendinopathy?

Tibialis Posterior Tendinopathy, a condition that disrupts the tibialis posterior tendon’s normal function, often triggers foot arch pain and discomfort. Situated along the lower leg’s interior, behind the ankle bone, and extending to the midfoot, this tendon plays a pivotal role in supporting the foot’s arch and ankle stability. It is also known as Posterior Tibial Tendon Dysfunction (PTTD). It is a common cause of foot arch pain and can predispose you to plantar fasciitis, flat feet and heel spurs.

The Mechanics of Tendinopathy

Tendinopathy refers to the pain or dysfunction of a tendon, a problem that can emerge suddenly or develop over time due to repetitive loads. Aging frequently leads to structural changes in the tendon’s collagen, which can result in increased foot arch falling in or pronation, particularly noted in older women. Nonetheless, factors like a change in activity levels, inadequate footwear, or prior ankle injuries can also contribute to this condition across different age groups.

Spotting Posterior Tibial Tendon Dysfunction

Posterior Tibial Tendon Dysfunction (PTTD) can arise from various causes, such as overtraining, abrupt changes in training surfaces, or even excessive uphill running. It manifests when the load on the tibialis posterior tendon—whether compressive, tensile, or a combination—exceeds what it can adapt to.

Common Causes of Tibialis Posterior Tendinopathy

Load-related factors, like sudden increases in training intensity or transitioning to harder training surfaces, often precipitate tendinopathy. Biomechanical issues such as flat feet, inadequate hip and knee control, or tight calf muscles also contribute significantly to the problem.

Diagnosing Tibialis Posterior Tendinopathy

Tibialis Posterior Tendinopathy
Tibialis Posterior Tendinopathy

A physiotherapist can diagnose Tibialis Posterior Tendinopathy through clinical assessment, relying on the history of symptoms and a physical examination. Unlike other conditions, PTTD typically does not necessitate imaging for diagnosis.

Tibialis Posterior Tendinopathy Treatment Approaches

Effective management of Tibialis Posterior Tendinopathy is multifaceted. It involves decompression, load management, progressive loading of the tendon, and addressing biomechanical factors that contribute to the condition.

Decompression and Load Management

The initial step in treating PTTD involves reducing the abusive load on the tendon by identifying and modifying activities that exacerbate the condition. Lower-impact training and additional foot support can be integral to managing the pain in the short term.

Progressive Loading

A cornerstone of PTTD management, progressive loading strengthens the tendon gradually. Exercises may start with isometric actions and advance through concentric, eccentric, and plyometric stages, increasing the load progressively.

Biomechanical Considerations

Addressing biomechanical contributors is essential. This may encompass exercises for foot stability, hip and glute strengthening, core stability, and proprioception. For some, podiatric input may be necessary to facilitate recovery with extra footwear support.

Expected Outcomes

PTTD generally has a favourable prognosis with early identification and treatment. However, cases with delayed diagnosis may require more comprehensive management involving both physiotherapy and podiatry. The rehabilitation program will be tailored to each individual’s response to treatment, guided by clinical testing and personal goals.

Exploring Novel Therapies

While novel treatments like injection therapies and shockwave therapies offer mixed results, they remain an area of active research. A physiotherapist can discuss whether such treatments are appropriate on a case-by-case basis.


Tibialis Posterior Tendinopathy, a significant cause of foot arch pain and dysfunction, requires a structured approach for effective management. By understanding the causes, implementing a personalised treatment plan that includes decompression, load management, and progressive loading, and addressing any biomechanical factors, individuals can expect a return to their daily activities and sports with reduced risk of recurrence. As with any medical condition, early diagnosis and treatment are crucial, and ongoing research continues to refine these approaches for even better outcomes.

For specific treatment advice, please book an appointment with your PhysioWorks physiotherapist.

Common Ankle Injuries

Welcome to an exploration of common ankle injuries. The ever-present sprained ankle is at the forefront, accompanied by various sources contributing to ankle pain. Fractures, stress fractures, and tendinopathies are part of this landscape, each with implications. Ankle impingement and foot posture issues emerge, and biomechanical issues take centre stage, affecting alignment and eventually fast-tracking ankle arthritis. Even the younger population experiences heel concerns, with Severs disease impacting many young athletes' seasons. This article serves as a concise guide to understanding the complexities of ankle problems.

Sprained Ankles

The most common ankle injury is a sprained ankle, but ankle pain can have numerous sources.

Ankle Fractures

An ankle fracture occurs when there is a break in one or more of the bones. The most common ankle fractures are avulsion fractures of your distal fibula, which can be a side effect of an ankle sprain. All suspected fractures require medical investigation and professional management by your health professional to avoid long-term foot and ankle issues. If your healthcare professional suspects an ankle fracture, you will be referred for at least an X-ray and potentially an Orthopaedic Surgeon.

Ankle Tendinopathies

While muscle strains are more common in your legs, there are essential muscles that converge into tendons that wrap around your ankle to stabilise your ankle and foot to protect them from sprains and allow you to walk and run. These muscles and their tendon vitally provide a normal foot arch and avoid flat feet. Your muscles or tendons can become injured or inflamed due to overuse or trauma. The inflammation is called tendonitis. They can also tear, completely rupture, or sublux out of place. Medically tendon injuries are known as tendinopathies, and at the ankle may include:

Ankle Arthritis

Your ankle pain and dysfunction can lead to degenerative conditions such as ankle osteoarthritis. While arthritis usually is a chronic deterioration of your ankle joint, it is crucial to slow ankle arthritis progression. Would you please seek the professional advice of your ankle and foot health practitioner, e.g. physiotherapist or podiatrist?

Biomechanical Conditions

Biomechanical disorders may result in foot deformation, painful weight-bearing and potentially nerve compression. In simple terms, this is where your foot and ankle do not have normal bone alignment and motion control. Here are a few possible conditions related to poor ankle biomechanics.

Muscle Injuries

Nerve-Related Ankle Pain

Children & Youth Conditions

Systemic Conditions That May Cause Ankle Pain

Soft Tissue Inflammation

Other Useful Information

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