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  • Writer's pictureDr. Ndidi Ufondu, DPM

Posterior Tibial Tendonitis: Causes, Symptoms, Treatments

As a podiatrist, I frequently treat patients struggling with posterior tibial tendonitis - inflammation of the tendon supporting the inner arch. This overuse injury causes inside ankle pain, arch collapse, and progressive flatfoot deformity if not promptly addressed.

Understanding the anatomy and biomechanics related to posterior tibial issues allows me to provide effective, multi-faceted treatment restoring function and preventing long-term joint damage. Here’s an in-depth guide on causes, symptoms, and evidence-based care for this common concern.

Anatomy and Function of the Posterior Tibial Tendon

The posterior tibial tendon originates in the calf muscles, courses down behind the inner ankle, and attaches along the inner arch’s bony prominences. Acting like a dynamic suspension bridge cable, it maintain the arch’s structural integrity.

It plays a crucial role supporting our body weight during standing, walking, running - especially in push-off. Unfortunately, this tendon endures substantial repetitive loads making it prone to painful inflammation.

How Posterior Tibial Tendonitis Develops

While acute injuries can occur, posterior tibial tendonitis more often emerges gradually from cumulative minor strain. Contributing factors include:


  • High volume athletic training lacking rest periods

Intrinsic foot structure

  • Rigid, flatfoot alignment increases strain on the tendon


  • Ankle sprains/fractures alter adjacent soft tissue forces


  • Declining circulation and elasticity with aging



  • Nerve damage and impaired blood supply slows healing

Inflammatory diseases

  • Associated conditions like rheumatoid arthritis or lupus

Eventually microscopic tears cause persistent swelling and irritation inside the ankle. Early diagnosis and care helps avoid progression to larger tears or rupture.

Recognizing Posterior Tibial Tendonitis Signs

Many patients first notice pain along the inner ankle with a recent uptick in athletic activity. Additional hallmark symptoms include:

  • Swelling and warmth along the tendon’s path

  • Tenderness when squeezed behind the ankle

  • Pain when standing on tiptoes

  • Difficulty lifting the arch properly when walking

  • Eventual arch flattening resulting in a slapping gait

  • Foot rolling inwards excessively (overpronation)

I also assess risk factors like age, weight, and medical history when evaluating patients. X-rays, ultrasounds, or MRI scans help gauge structural damage guiding appropriate treatments.

Evidence-Based Posterior Tibial Tendonitis Treatments

Initially, therapy focuses on alleviating irritation allowing the tendon to rest and heal. I tailor combinations of:

Immobilization boot

  • Limits ankle motion to calm inflammation

Physical therapy

  • Stretches calf muscles and stimulates healing


  • Supports arch reducing strain on tendon


  • Oral medication combined with topical gels


  • Limits excess foot flattening motion


  • Platelet-rich plasma or steroid injections reduce swelling

Patients require 4-6 months rest from aggravating activity for optimal recovery. I then advise gradually transitioning back based on ongoing symptoms and functional gains.

Posterior Tibial Tendonitis Self-Care

For long-term relief, I provide tailored home care regimens focused on:

Rest periods

  • Taking days off from intense lower limb exercise

Ice massage

  • Applying ice directly to the tendon in 10 minute intervals

Contrast baths

  • Alternating hot and cold water immersion

Calf stretching

  • Easing tight muscles reducing strain on the tendon

Foot strengthening

  • Intrinsic exercises enhance arch stability offloading the tendon

Arch support

  • Over-the-counter orthotics or arch taping between appointments

Proper footwear

  • Shoes with cushioning and stability minimizing irritation

Educating patients empowers them to take an active role minimizing recurrence between podiatry visits. I monitor their home exercise compliance and evolving symptoms to make appropriate care adjustments.

When to See a Podiatrist for Posterior Tibial Issues

See a podiatrist promptly if you experience:

  • Ongoing stiffness, swelling, and inside ankle pain

  • Inability to complete heel raises due to discomfort

  • Progressively collapsing arches or flatfoot deformity

  • Limping gait from arch instability

  • Worsening pain despite rest and over-the-counter anti-inflammatories

While partial tears may heal with conservative care, delays seeking treatment risks total rupture. This permanently compromises the tendon’s ability to dynamically support the arch - requiring surgery. Early intervention optimizes outcomes.

Skilled Podiatric Care Keeps You Active

The posterior tibial tendon bears considerable load during daily walking and athletic endeavors. With time, this indispensable connective tissue suffers cumulative damage from sheer repetitive use.

Combining smart training habits and rapid podiatric treatment at the earliest signs of pain allows maintaining an active lifestyle long-term. My comprehensive understanding of lower limb biomechanics informs personalized rehabilitation programs and prevention strategies.

If nagging ankle discomfort or collapsing arches start interfering with your quality of life, make an appointment to get evidence-based care keeping you on your feet pain-free. With multi-modal therapies, you can confidently stay active relying on your feet again.

Key Takeaways

  • Posterior tibial tendonitis causes inside ankle pain from arch support tendon inflammation

  • Recognize early signs like swelling, arch flattening to optimize treatment

  • Podiatrists offer bracing, injections, and physical therapy for pain relief

  • Self-care like stretching, ice, and orthotics aid recovery between appointments

  • Don’t delay with worsening ankle symptoms which risks tendon rupture

  • Combining treatments and training adjustments allows continuing active lifestyles


What causes posterior tibial tendonitis?

Frequent overloading with running, jumping activities strains the tendon over time. Intrinsic flat or rigid foot alignment also increases risk. Other factors include age over 40 years old, obesity, and inflammatory diseases.

How do you differentiate posterior tibial tendonitis from Achilles tendonitis?

Location differentiates the two. Posterior tibial involves the inner ankle, while Achilles affects the back outer ankle. Activities aggravating symptoms also differ based on specific tendon function.

When should surgery be considered for posterior tibial issues?

Surgery may be indicated after 6-12 months of dedicated conservative therapy in patients with severe, non-healing tendon damage, or in cases of total rupture where the tendon can’t be repaired nonsurgically.

Can custom orthotics help posterior tibial tendonitis if I don't have arch support shoes?

Yes, custom orthotics work as part of a multifaceted treatment plan by supporting the arch and offloading strain on the injured tendon. Wear orthotics in all shoes until pain and function improves.


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