Posterior Tibial Tendon Dysfunction

May 16, 2017 | By | Reply

Posterior tibial tendon dysfunction is the most common cause of adult acquired flatfoot disease.

The posterior tibial tendon is little-known, but hugely important anatomical structure along the inside of your ankle. The tendon itself is not much thicker than a pencil, but it plays an essential role in stabilizing your foot.

The posterior tibial tendon is one of the most important tendons of the leg. A tendon attaches muscles to bones, and the posterior tibial tendon attaches the tibialis posterior muscle to the bones on the inside of the foot.

By applying tension along the inside of your ankle, the tibialis posterior muscle and the posterior tibial tendon play a critical role in maintaining your arch and supporting your foot.

Anatomy of the ankle, with the area of pain highlighted in red

Any time you run or walk, your posterior tibial tendon locks your ankle in place, helping to hold your foot in a strong, rigid configuration when you push off the ground. It also functions to invert your foot, rolling your ankle to shift your weight to the outside of your foot.


  • An acute injury, such as from a fall, can tear the posterior tibial tendon or cause it to become inflamed.
  • The tendon can also tear due to overuse. For example, people who do high-impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time.
  • Rolling of the feet on inside border every time you walk, run, jump or do any weight bearing activity.
  • Tightness of the calf muscle.
  • Lower limb biomechanical dysfunction.
  • Posterior tibial tendon dysfunction is more common in women and in people older than 40 years of age.


  • Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area.
  • Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time.
  • In extreme cases , pain on the outside of the ankle. When the foot collapses inside, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone.


Stage 1: Inflamed, intact tendon without change in foot shape.
Stage 2: The tendon begins to become elongated, and the arch gradually flattens.
Stage 3 & 4: The tendon may be partially or fully ruptured. Advanced foot deformity with Back of foot osteoarthritis and ankle joint involvement too.


  • MRI or USG is done to identify extent of damage along with physical testing.


  • Obesity
  • Hypertensions
  • Diabetes
  • Steroid use
  • Previous injury
  • Trauma


  • Treatment depends on stage of problem.
  • Early intervention of faulty foot alignment can prevent this problem.


  • Wear supportive shoes and orthotics all the time, even when you’re just walking around the house.
  • Calf stretching, sole to sole exercises, strengthening of muscles around ankle joint & functional exercises.
  • Exercises for foot muscles that support the arch.
  • Balance exercises.
  • Gait Training.
  • Taping.
  • Ice to control pain, especially after doing your rehab exercises.


  • If the above fail or the condition is in stage 3 & 4 , Surgery is the main stay of treatment.

We at PHYSIOREHAB specialise in evaluation and diagnosis of foot and ankle problems, prescribe individualised treatment protocol based on your evaluation and prescribe foot specific orthotics.

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