Posterior Tibial Tendonitis Signs and Treatment

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Posterior tibial tendonitis is a common problem that occurs when one of the tendons on the inner side of the ankle becomes damaged. This can lead to foot and ankle pain, as well as other issues.

Treatment varies depending on the severity of the condition and may include rest, immobilization, medication, and surgery.

This article explains what this condition is, how it occurs, the symptoms to watch out for, and how to treat it.

The posterior tibial tendon helps support the arch of the foot while walking or running.

Symptoms of posterior tibial tendonitis
Verywell / Cindy Chung

Posterior Tibial Tendon Anatomy

The posterior tibial muscle attaches to the back of the shin bone. The posterior tibial tendon connects this muscle to the bones of the foot. A tendon is a thick cord of tissue that attaches a muscle to a bone.

The posterior tibial tendon passes down the back of the leg, not far from the Achilles tendon. It then turns under the inner side of the ankle. Here, it attaches to the bone of the inner side of the foot, just next to the arch of the foot.

Posterior tibial tendon problems usually occur just underneath the inner side of the ankle, called the medial malleolus. The medial malleolus is the end of the shin bone (the tibia). It's the big bump you feel on the inside of your ankle. The posterior tibial tendon wraps just underneath the medial malleolus.

This area of the tendon is particularly prone to problems—it exists in a "watershed zone," where the blood supply is weakest. So when the tendon becomes injured from trauma or overuse, the body has trouble delivering the proper nutrients for healing.

Posterior Tibial Tendonitis Symptoms

Most commonly, people with posterior tibial tendonitis:

  • Feel pain on the inner side of the foot and ankle
  • May have an unsteady gait
  • May have trouble maintaining stability while walking

Many people with this condition report having had a recent ankle sprain. However, some will have had no recent injury. The tendon can also be damaged from overuse.


Click Play to Learn All About Treating Posterior Tibial Tendonitis

This video has been medically reviewed by Oluseun Olufade, MD.

As the condition gets worse, the foot's arch can flatten, and the toes begin to point outwards. This is the result of the posterior tibial tendon not doing its job to support the arch of the foot.

Adult-Acquired Flatfoot Deformity

When left untreated, posterior tibial tendonitis can gradually bring on a problem called adult-acquired flatfoot deformity (AAFD), also known as a "fallen arch." This condition typically begins with pain and weakness of the tendon.

As AAFD advances, the ligaments of the foot are affected. The foot joints may no longer line up correctly and may become set in the wrong position. For this reason, most physicians prefer early treatment before the later stages of AAFD.


A podiatrist, or doctor who specializes in foot and ankle problems, can diagnose posterior tibial tendonitis by physical examination. People with the condition have:

  • Tenderness and swelling along the posterior tibial tendon
  • Weakness when trying to point their toes inward
  • Trouble standing on their toes on the affected side

If the examination is unclear or your doctor is considering surgical repair, they may order a magnetic resonance imaging (MRI) scan. The MRI can determine whether the tendon has ruptured, and where. It can also show inflammation surrounding the tendon.


Posterior tibial tendonitis is classified according to the stage of the condition. Stage 1 through stage 4 indicate increasing deformity (abnormal shape) of the foot as the condition progresses:

  • Stage 1: The earliest stage is having pain and swelling along the tendon. The foot may appear completely normal. On the other hand, some people may notice their foot has a mild flatfoot deformity. This may be something they feel they have always had.
  • Stage 2: As the condition progresses, the arch of the foot begins to collapse. When they stand, the foot appears flat along its inner side. At this stage, it may be possible to correct the flattened arch.
  • Stage 3: In stage 3 of the condition, called a rigid flatfoot deformity, a physician cannot easily correct the foot.
  • Stage 4: In stage 4, not only is the foot involved, but the adjacent ankle joint also is affected by the condition.

As these stages progress, more extensive treatments are needed to correct the problem.

Nonsurgical treatment can be used at any stage. However, the chances of success with these options decrease as the condition progresses.

Posterior Tibial Tendonitis Treatment

Treatment varies depending on the stage of the tendonitis. In the early stage, it mostly involves rest. Later, it may require surgery.

Early Treatment

The initial treatment of posterior tibial tendonitis is rest so that the tendon can heal. Unfortunately, even normal walking may get in the way of allowing the tendon to heal adequately.

Options for early treatment include:

  • Shoe inserts and arch supports, which prevent motion between the middle and back of the foot and decrease inflammation
  • Walking boots, which can help decrease inflammation
  • Casts, which are the safest method to ensure the tendon is adequately rested
  • Anti-inflammatory medications, which help reduce inflammation around the tendon
  • Limiting activity, which can help the tendon rest and reduce inflammation around it
  • Cortisone shots, which may be injected around the posterior tibial tendon to reduce inflammation and pain
  • Physical therapy, which may include stretching and strengthening exercises, as well as massage

Research also suggests that taping may help reduce improper movement of a functional posterior tibial tendon and slightly increase muscle activity for the first 15 minutes of running.

Surgical Options

Surgical treatment of posterior tibial tendonitis is controversial. Surgical options vary depending on the extent of the condition and include:

  • Debridement: In the early stage, some surgeons may recommend a procedure to clean up the inflammation. During debridement, the inflamed tissue and abnormal tendon are removed. This allows for the healing of the damaged tendon.
  • Reconstruction: In more advanced stages, the arch of the foot collapses and your doctor may surgically reconstruct the area. This involves using a neighboring tendon, called the flexor digitorum longus, to replace the damaged posterior tibial tendon. Bones in the foot may be cut and reshaped to create a new arch, as well.
  • Fusion: Finally, in the most advanced cases, when the foot's arch has become rigid, doctors often prefer a fusion procedure, where the bones and joints in the foot are fixed in place to restore the arch.


Posterior tibial tendonitis is a condition that results in pain on the inner side of the foot and ankle. It may cause instability while walking. Over time, the condition can lead to the arches becoming flattened, a condition called adult-acquired flatfoot deformity (AAFD).

Your doctor will diagnose this condition based on a physical examination and imaging techniques. Treatment depends on how advanced the condition is.

A Word From Verywell

Posterior tibial tendonitis and adult-acquired flatfoot deformity can be frustrating problems. Often, people feel their discomfort and instability are ignored by a doctor who may not recognize the problem.

However, it's best to treat the condition early, before it gets worse. So, it's important to find a doctor who will listen to you and take your symptoms seriously.

Once in the later stages, surgery is usually needed, and you may lose some function in your foot. For these reasons, early treatments such as wearing a cast, boot, or brace and getting physical therapy are important.

Frequently Asked Questions

  • Are there exercises that help with posterior tibial tendonitis?

    Yes, there are exercises that help with posterior tibial tendonitis. However, it's best to contact your healthcare provider before trying any exercises to see which ones will work best for you.

  • What are the risks of posterior tibialis tendon surgery?

    The risks include excess bleeding, a blood clot, nerve damage, infection, calf muscle weakness, anesthesia complications, and continued pain in the foot or ankle. However, these can vary depending on your age, general health, the type of surgery, and your foot's anatomy.

  • What does swelling on the inner ankle mean?

    The first stage of posterior tibial tendonitis involves swelling of the tendon on the inner side of the ankle. Reach out to your healthcare provider if you have concerns about the health of your inner ankle.

  • Do compression socks help posterior tibial tendonitis?

    Compression socks may help with pain and soreness, but more research is needed.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Bubra PS, Keighley G, Rateesh S, Carmody D. Posterior tibial tendon dysfunction: an overlooked cause of foot deformityJ Family Med Prim Care. 2015;4(1):26–29. doi:10.4103/2249-4863.152245

  2. Ling SK, Lui TH. Posterior Tibial Tendon Dysfunction: An Overview. Open Orthop J. 2017;11:714-723. doi:10.2174/1874325001711010714

  3. Deland JT, Page A, Sung IH, O'Malley MJ, Inda D, Choung S. Posterior tibial tendon insufficiency results at different stagesHSS J. 2006;2(2):157–160. doi:10.1007/s11420-006-9017-0

  4. Ikpeze TC, Brodell JD Jr, Chen RE, Oh I. Evaluation and treatment of posterior tibialis tendon insufficiency in the elderly patientsGeriatr Orthop Surg Rehabil. 2019;10:2151459318821461. doi:10.1177/2151459318821461

  5. American Academy of Orthopaedic Surgeons. Posterior tibial tendon dysfunction.

  6. Siu WS, Shih YF, Lin HC. Effects of Kinesio tape on supporting medial foot arch in runners with functional flatfoot: a preliminary studyResearch in Sports Medicine. 2020;28(2):168-180. doi:10.1080/15438627.2019.1638258

  7. Wake J, Martin K. Posterior tibial tendon endoscopic debridement for stage I and II posterior tibial tendon dysfunctionArthrosc Tech. 2017;6(5):e2019–e2022. doi:10.1016/j.eats.2017.07.023

  8. Marks RM, Long JT, Ness ME, Khazzam M, Harris GF. Surgical reconstruction of posterior tibial tendon dysfunction: prospective comparison of flexor digitorum longus substitution combined with lateral column lengthening or medial displacement calcaneal osteotomy. Gait Posture. 2009;29(1):17-22. doi:10.1016/j.gaitpost.2008.05.012

  9. Johns Hopkins Medicine. Posterior tibialis tendon surgery.

  10. Montoye AHK, Mithen AA, Westra HL, Besteman SS, Rider BC. The effect of compression socks on maximal exercise performance and recovery in insufficiently active adultsInt J Exerc Sci. 2021;14(7):1036-1051.

Additional Reading

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.