Tibialis Posterior Tendinopathy

Tibialis Posterior Tendinopathy



Tibialis posterior tendinopathy is an issue which we see regularly at Harris & Ross. It is an  overuse injury which causes pain and swelling behind the inner anklebone down to the middle of the foot. It is common in middle-aged women. Find out more about this condition and how we go about treating it below:


Tibialis Posterior Anatomy

The tibialis posterior muscle runs from the back of the shinbones (tibia and fibula) down the back of the leg. The tendon of tibialis posterior runs behind the inner bony bump on the ankle (medial malleolus), which it then winds around before attaching into bones at the middle of the foot. The tibialis posterior works to stabilise the arch of the foot and helps provide stability for the ankle.



Tibialis posterior tendinopathy is largely an overuse injury. Repetitive stress to the tendon can cause it to break down and become weaker, this in turn means it is less able to tolerate load, which perpetuates the problem.


The overloading of the tendon can be due to a number of reasons, including:

  • Fast increase in the volume or intensity of training
  • Foot mechanics – flat feet /over pronated feet
  • Footwear (high heels will put more stress through the tendon, as will poorly supportive footwear)
  • Poor strength
  • Ankle stiffness
  • Poor biomechanics


Other causes for tibialis posterior tendinopathy include Acute injury:

  • Direct trauma, such as a laceration
  • Indirect trauma, such an an eversion ankle sprain or an ankle fracture
  • Acute avulsion injury – where the tendon pulls off a bit of bone due to the force exerted on it
  • Inflammatory conditions are another cause of pain, such as Tenosynovitis, where the sheath of the tibialis posterior tendon becomes inflamed. This is commonly secondary to conditions like Rheumatoid Arthritis


Signs and Symptoms

Common symptoms of tibialis posterior tendinopathy include:

  • Pain behind the bony bump on the inner ankle (medial malleolus), extending toward the middle of the foot
  • Swelling around the inner ankle
  • Crepitus – noise created through the tendon rubbing against other structures may be present
  • Pain and weakness with turning the foot inwards
  • Pain walking and running



Treatment involves conservative physiotherapy with an emphasis on improving the load capacity of the tendon, and addressing any other contributing factors found on assessment.

Physiotherapy and Podiatry treatment may include:

  • Reducing load /modifiying the amount of activity
  • Ice for pain relief
  • Strengthening the tibialis posterior muscle and tendon
  • Addressing muscle weakness elsewhere in the chain, notably glutes
  • Re-training good movement patterns
  • Correcting biomechanical errors
  • Soft tissue release
  • Orthotics
  • Return to running / sport specific exercise program

Surgical repair may be advocated if conservative rehabilitation has failed.

To make an appointment for an initial physio assessment at our Wilmslow, Manchester, Altrincham or Wigan clinics, and discuss a treatment plan for your hamstring strain call Harris & Ross on 0161 832 9000 or click the book now icon below.