Tibialis Posterior – Symptoms, Causes, and Treatment Options

Overview of Tibialis Posterior

The tibialis posterior is a deep muscle in the calf that runs down the back of your leg, around the inside of your ankle, and attaches to bones in your foot. Its main jobs are to support the arch of your foot and help with movements such as walking, pushing off the ground, or balancing on uneven surfaces. When the tibialis posterior tendon is injured or inflamed, it’s often called posterior tibial tendon dysfunction (PTTD).

This condition is relatively common, especially in adults over the age of 40, women, and people who spend long hours standing or walking. Studies suggest that PTTD may affect up to 10% of middle-aged women, though prevalence varies depending on how it’s defined and the population studied (Johnson & Strom, 1989; Bluman et al., 2007).

Impact on daily life:

• Work: Jobs that require standing or walking may become difficult. Retail staff, healthcare workers, and teachers are especially affected.
• Sport: Athletes, runners, or people doing high-impact activities often feel limited by pain and instability.
• Sleep: Ongoing discomfort and throbbing pain can interrupt rest.
• Relationships & mental health: Persistent pain often leads to frustration, stress, and reduced activity, which may impact mood and social life.

In short, tibialis posterior problems are not just about ankle pain — they can interfere with mobility, independence, and overall quality of life.

Authoritative reference:

Bluman EM, Title CI, Myerson MS. (2007). Posterior tibial tendon rupture: a refined classification system. Foot Ankle Clin. 12(2):233-249. doi:10.1016/j.fcl.2007.03.004

Symptoms of Tibialis Posterior Problems

The main symptom of tibialis posterior dysfunction is pain along the inside of your ankle and foot. This pain often worsens with activity, such as walking or climbing stairs, and may ease with rest. Early on, the tendon may feel sore or swollen. Over time, if untreated, the arch of the foot may begin to flatten, leading to more noticeable changes in how you walk.

Common symptoms include:

• Pain and tenderness along the inside of the ankle or arch.
• Swelling around the tendon.
• A flattening arch (flatfoot).
• Difficulty standing on tiptoes or pushing off while walking.
• Pain that spreads to the outside of the ankle as the foot becomes unstable.

Severity spectrum:

1. Mild cases: Occasional soreness or stiffness after long walks or standing.
2. Moderate cases: Persistent pain with swelling, difficulty in sports or daily activities.
3. Severe cases: Significant arch collapse, difficulty walking, and pain even at rest.

Impact on daily life:

• Work: You may struggle with long shifts on your feet.
• Sports: Running, dancing, or even brisk walking can feel impossible.
• Sleep: Throbbing pain at night may disturb rest.
• Mood & relationships: Living with constant foot pain can make you feel isolated or discouraged.

Red flag signs – when to seek care immediately:

• Sudden sharp pain and swelling after an injury.
• Rapid flattening of the foot with loss of arch.
• Inability to stand or walk without severe pain.

Comparison with other conditions: Tibialis posterior dysfunction is often confused with plantar fasciitis (heel pain), but plantar fasciitis pain is mostly under the heel, while tibialis posterior pain runs along the inner ankle and arch.

Authoritative reference:

Johnson KA, Strom DE. (1989). Tibialis posterior tendon dysfunction. Clin Orthop Relat Res. 239:196–206. PMID: 2910619

Causes and Risk Factors for Tibialis Posterior Problems

Tibialis posterior issues typically develop from a combination of overuse, poor biomechanics, and lifestyle factors. The tendon can become inflamed (tendinitis) or degenerate (tendinopathy). In some cases, it may tear partially or completely.

Common causes:

• Overuse injuries: Repetitive stress from running, walking long distances, or standing for hours.
• Biomechanical strain: Flat feet, high arches, or improper gait put extra pressure on the tendon.
• Injury or trauma: A fall, ankle sprain, or sudden twist of the foot can damage the tendon.

Risk factors include:

• Age: More common in people over 40, as tendons naturally weaken.
• Gender: Women are affected more often than men.
• Obesity: Extra weight adds stress to the tendon and arch.
• Occupation: Jobs requiring long periods of standing or walking increase risk.
• Pregnancy: Hormonal changes and added weight may increase strain on the tendon.
• Footwear: Poorly supportive shoes, especially flat shoes or unsupportive sandals, contribute to stress on the tendon.

Lifestyle and health considerations:

Sedentary lifestyle weakens supporting muscles, while excessive high-impact activity can overload the tendon.

Conditions such as diabetes or hypertension are linked with poorer tendon health.

Comparison with similar conditions: Unlike Achilles tendon problems, which cause pain at the back of the heel, tibialis posterior dysfunction causes pain on the inner side of the ankle and under the arch.

Authoritative reference:

Kohls-Gatzoulis J, Angel JC, Singh D, Haddad F, Livingstone J, Berry G. (2004). Tibialis posterior dysfunction: a common and treatable cause of adult acquired flatfoot. BMJ. 329(7478):1328–1333. doi:10.1136/bmj.329.7478.1328

Diagnosis, Recovery, and Management of Tibialis Posterior

The tibialis posterior tendon plays a vital role in stabilizing your ankle and supporting your arch. When it becomes strained or damaged, diagnosis and treatment are essential to prevent long-term complications like flatfoot. Below, you’ll learn how tibialis posterior dysfunction is diagnosed, how long recovery usually takes, and practical management strategies to support healing and prevent recurrence.

Diagnosis of Tibialis Posterior Dysfunction

Tibialis posterior dysfunction is diagnosed through a combination of physical examination, imaging tests, and a review of your symptoms. Practitioners look for signs of tendon damage, loss of arch support, and functional changes in your gait or balance.

How do doctors test for tibialis posterior problems?

Doctors begin with a clinical history. They will ask about your pain (where it is, when it happens, and what makes it better or worse), your activity level, past injuries, and footwear habits. This helps rule out other causes of ankle or foot pain, such as plantar fasciitis (heel pain) or Achilles tendinopathy (back of the heel pain).

Physical exam tests include:

• Palpation: Pressing along the inside of your ankle and arch to check for tenderness or swelling.
• Single heel raise test: You are asked to stand on one leg and rise onto your toes. Difficulty or inability to do this is a strong indicator of tibialis posterior dysfunction.
• Gait assessment: Watching how you walk to see if your arch collapses or your foot rolls inward (overpronation).

What imaging is used to diagnose tibialis posterior dysfunction?

If the physical exam isn’t enough, imaging may be recommended:

1. Ultrasound: Shows tendon thickening, tears, or inflammation.
2. MRI: The most accurate test, providing detailed images of the tendon and surrounding structures.
3. X-rays: Help check for bone changes or advanced flatfoot deformity.

How do practitioners identify the root cause?

Diagnosis isn’t just about confirming tendon damage — it’s about finding why the tendon failed. Causes might include flatfoot, obesity, repetitive overuse, or injury. Understanding these risk factors helps guide the treatment plan.

Comparison with other conditions:

• Plantar fasciitis mainly causes heel pain.
• Achilles tendon problems affect the back of the heel.
• Tibialis posterior issues cause pain along the inside of the ankle and arch.

Authoritative reference:

Kohls-Gatzoulis J, Angel JC, Singh D, Haddad F, Livingstone J, Berry G. (2004). Tibialis posterior dysfunction: a common and treatable cause of adult acquired flatfoot. BMJ, 329(7478):1328–1333. doi:10.1136/bmj.329.7478.1328

Recovery Timeline for Tibialis Posterior Dysfunction

Recovery from tibialis posterior dysfunction depends on the severity of tendon damage and how early treatment begins. Healing times range from weeks in mild cases to months (or longer) in severe cases requiring surgery.

How long does tibialis posterior usually take to heal?

Mild cases (tendon irritation or early dysfunction):

• Recovery often takes 6–8 weeks with rest, supportive footwear, and physiotherapy.

Moderate cases (tendon degeneration, pain during daily activities):

• Recovery may take 3–6 months, especially if bracing or immobilization is needed.

Severe cases (tendon rupture, collapsed arch):

• Surgery is often required, with recovery times of 6–12 months and ongoing rehabilitation.

What factors affect recovery?

• Adherence to treatment: Wearing braces, doing exercises, and avoiding aggravating activities help healing.
• Weight management: Extra body weight increases tendon stress and slows recovery.
• Footwear choices: Supportive shoes speed recovery; flat or unsupportive shoes worsen symptoms.
• Underlying health: Diabetes, hypertension, or poor circulation can delay tendon healing.

Return-to-work, return-to-sport, and long-term outcomes

• Work: Many people can return to desk work quickly, but jobs involving long standing may need weeks of recovery.
• Sport: Runners, dancers, and athletes may need structured rehab and at least 3–6 months before full return.
• Lifestyle: Long-term arch support (orthotics or supportive shoes) is often needed to reduce recurrence risk.

If/then recovery pathway

1. If your case is mild, then early rest, exercise, and footwear changes usually resolve symptoms in weeks.
2. If your case is moderate, then a longer rehab plan with bracing and structured therapy is needed.
3. If your case is severe, then surgery may be necessary, followed by months of structured rehab.

Authoritative reference:

Bluman EM, Title CI, Myerson MS. (2007). Posterior tibial tendon rupture: a refined classification system. Foot Ankle Clin, 12(2):233-249. doi:10.1016/j.fcl.2007.03.004

Management of Tibialis Posterior Dysfunction

Management focuses on reducing pain, improving foot function, and preventing further tendon damage. Treatment may include self-care, physical therapy, and lifestyle changes.

What’s the best way to manage tibialis posterior at home?

Self-help & relief tips:

• Rest & protect: Avoid high-impact activities until pain improves.
• Ice therapy: Apply an ice pack for 15–20 minutes to reduce swelling.
• Supportive footwear: Choose shoes with strong arch support and cushioning.
• Orthotics: Custom or over-the-counter inserts help support your arch.
• Strengthening exercises: Gentle calf raises and resistance band exercises strengthen the tendon.
• Stretching: Stretching the calf and Achilles tendon reduces strain on the tibialis posterior.

These steps provide initial relief, but long-term management often requires professional guidance.

How do therapy and lifestyle changes help?

• Physiotherapy: Strengthening and balance training to restore tendon function.
• Bracing/immobilization: A walking boot or brace may be prescribed for moderate cases.
• Surgery: Reserved for severe tendon tears or advanced flatfoot deformity.

Prevention strategies

• Maintain a healthy weight to reduce tendon stress.
• Wear supportive shoes, especially for long hours on your feet.
• Avoid sudden increases in activity without proper conditioning.
• Build overall foot and ankle strength with regular exercises.
• Broader lifestyle & mental health impact

Living with tibialis posterior dysfunction can be frustrating. Pain may limit social activities, sports, or work. Structured management helps restore not just physical function but also confidence, independence, and quality of life.

Authoritative reference:

Kulig K, Reischl S, Pomrantz AB, Burnfield JM, Mais-Requejo S, Thordarson DB, Smith RW. (2009). Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise: a randomized controlled trial. Phys Ther, 89(1):26–37. doi:10.2522/ptj.20070194

Multidisciplinary Coordinated Care for Tibialis Posterior at CARESPACE

CARESPACE provides a unique, multidisciplinary approach to tibialis posterior dysfunction by combining physical rehabilitation, lifestyle guidance, and mental health support into one coordinated care plan. This team-based model helps you recover faster, manage pain more effectively, and prevent recurrence compared to traditional single-discipline treatments.

How does CARESPACE treat tibialis posterior dysfunction differently?

At CARESPACE, you aren’t limited to just one type of care. Instead, you benefit from a team of healthcare professionals working together on your recovery. While most clinics may only offer one type of service, CARESPACE integrates physiotherapy, chiropractic care, massage therapy, kinesiology, psychotherapy, nutrition, acupuncture, and fitness training into a single plan tailored for you.

• A physiotherapist may start by assessing your tendon, prescribing corrective exercises, and guiding you through safe movement.
• A chiropractor can support joint alignment and reduce biomechanical stress on your ankle.
• Massage therapy helps ease calf and foot tension, improving circulation and comfort.
• A kinesiologist provides corrective exercise and strength training for long-term stability.
• Psychotherapy and mental performance coaching address pain-related stress, frustration, and sleep challenges.
• Nutrition and naturopathic medicine help with inflammation control, energy, and recovery.
• Acupuncture may reduce pain and support tissue healing.

This coordinated model means your care team regularly communicates, ensuring you don’t get fragmented or conflicting advice.

Why does a team approach help tibialis posterior recover faster?

A team approach works because tibialis posterior dysfunction affects more than just your tendon — it impacts how you move, sleep, and cope with daily life. By addressing every angle of recovery, CARESPACE helps you heal more efficiently and reduce the risk of future setbacks.

Benefits of multidisciplinary care:

1. Faster results: Coordinated input from different professionals means you get more complete treatment.
2. Lower recurrence risk: Strengthening, lifestyle coaching, and supportive therapies reduce future flare-ups.
3. Personalized plans: Every care plan is based on your unique symptoms, lifestyle, and goals.
4. Whole-person support: Physical, mental, and emotional health are addressed together.

Example scenario:

If you come in with inner ankle pain and swelling, your physiotherapist may begin with exercises and supportive bracing. At the same time, massage therapy reduces calf tightness, psychotherapy helps you manage the stress of limited mobility, and nutrition coaching provides anti-inflammatory strategies. This combined approach supports both your short-term recovery and your long-term resilience.

What does coordinated tibialis posterior care at CARESPACE look like?

CARESPACE organizes your treatment journey into clear phases: acute care, subacute recovery, and maintenance.

1. Acute Phase (first few weeks)

• Focus: Pain relief, rest, and protection.
• You may start with physiotherapy for gentle mobility, massage therapy for swelling, and bracing for tendon support.
• Acupuncture and nutrition strategies can be added for inflammation control.

2. Subacute Phase (weeks to months)

• Focus: Rebuilding strength, mobility, and balance.
• Kinesiology and physiotherapy lead corrective exercise programs.
• Chiropractic adjustments may improve joint mechanics.
• Psychotherapy and coaching address frustration, insomnia, or fear of re-injury.

3. Maintenance Phase (long-term)

• Focus: Prevention and lifestyle optimization.
• Ongoing fitness training, nutrition guidance, and supportive care keep your tendon strong.
• This phase helps you return to work, sport, and daily life without relapse.

How does CARESPACE address the mental health side of tibialis posterior dysfunction?

Chronic foot and ankle pain doesn’t just affect your body — it also affects your mind. Many people experience frustration, sleep problems, or even mood changes when pain limits their activity. CARESPACE integrates psychotherapy, mental performance coaching, and lifestyle strategies directly into your care plan.

• Psychotherapy: Helps you manage stress, pain-related anxiety, and coping strategies.
• Mental performance coaching: Supports motivation, goal-setting, and confidence in your recovery.
• Sleep and stress management: Coordinated with nutrition, exercise, and counselling to improve overall well-being.

This holistic care reduces the mental and emotional burden of living with a tendon condition, making it easier to stay engaged in treatment.

Why CARESPACE’s multidisciplinary care is more effective than single-discipline treatment

Traditional care for tibialis posterior dysfunction often relies on one discipline — for example, just physiotherapy or just bracing. While helpful, this narrow approach can miss the bigger picture.

CARESPACE’s advantage:

1. Integration: All providers collaborate and share notes to align your care.
2. Evidence-based practice: Treatment choices are supported by clinical research and guidelines.
3. Customization: Care is adapted to your stage of recovery (acute → subacute → maintenance).
4. Whole-person focus: Both physical recovery and mental well-being are prioritized.

The result is a cohesive, client-centered recovery pathway that helps you get back to work, sport, and life with greater confidence and reduced risk of recurrence.

With CARESPACE’s coordinated, multidisciplinary care, you don’t just treat your tibialis posterior dysfunction — you build lasting resilience, improve overall health, and regain control of your life.

Related Conditions for Tibialis Posterior Dysfunction

Tibialis posterior dysfunction can be confused with or occur alongside other foot and ankle conditions. These conditions often share similar symptoms, such as pain, swelling, and difficulty walking, which is why an accurate diagnosis is so important.

• Plantar fasciitis: Pain is mostly under the heel and worse in the morning, while tibialis posterior pain runs along the inner ankle and arch.
• Achilles tendinopathy: Pain is felt at the back of the heel, not the inside of the foot.
• Flatfoot (pes planus): Often both a cause and an effect of tibialis posterior dysfunction.
• Ankle sprains: Can mimic tendon pain but usually follow a distinct injury.
• Arthritis of the foot or ankle: Causes stiffness and pain that may overlap with tibialis posterior problems.

Looking for information on a different condition? Visit our full Conditions List.