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Posterior Tibial Tendon Dysfunction

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Posterior tibial tendon dysfunction tends to be one of the most common problems in the foot and ankle. It often occurs whenever the posterior tibial tendon is strained or becomes inflamed. The tendon might not be able to provide you with support and stability of the foot, which causes flatfoot to ensue. This is because the muscle and tendon help to maintain the arch of the foot so if the tendon degenerates, then the foot can become flat.

Most of the time, surgery isn’t required to treat the condition. Braces and orthotics are two of the most common forms of treatment. If they aren’t able to provide you with relief, surgery might be the only option to help alleviate pain. Surgery is often as simple as removing the inflamed tissue or repairing the tear. More times than not, surgery can become very involved. Many patients might find that there are limitations in their activities following surgery.

Posterior tibial tendon dysfunction is a typically an overuse injury that can occur for years before symptoms present. In many cases the foot becomes flat first, and that stretches the posterior tibial tendon, and in other cases, the tendon weakens causing the flat foot. Doctors are undecided which comes first.

To test if you have posterior tibial tendon dysfunction, you can first check to see if your foot is flat when standing. Secondly, your ability to stand on the toes on one foot (using a wall or table for support).

Posterior Tibial Tendon Dysfunction Anatomy

Three different bones compose the ankle joint: the shinbone (tibia), the smaller bone within the lower leg (fibula) and the small bone nestled between the heel bone and the fibula and the tibia (talus). Doctors will often classify the fracture based upon the area where the break occurred. Two joints are often involved when a fracture occurs: the ankle joint, which is where the talus, fibula and the tibia meet, and the syndesmosis joint, which is between the fibula and the tibia and held together with ligaments. It takes multiple ligaments to ensure the ankle joint is stable.

The posterior tibial tendon is one of the most important tendons throughout the entire leg. Tendons keep the muscles attached to the bones. This particular tendon attaches the calf muscles to the bones on the inside part of the foot. The main function in this tendon is to support the arch and foot when walking.

tibialis posterior anatomy image

How To Treat Posterior Tibial Tendon Dysfunction

1. Rest

Decrease or stop any activity that is causing pain to worsen on your first step. Switch to a low impact exercise like swimming, biking or an elliptical machine. Stop running or seek guidance from your musculoskeletal therapist.

2. Ice

Apply ice to the affected area for 5-10 minutes at a time three to five times per day. Ice can help
to alleviate swelling and inflammation in the affected area.

3. Anti-Inflammatory Medication

An anti-inflammatory medication can help to reduce inflammation and pain. Some athletes take the medication about ½ hour before beginning any exercise activity will help with limiting inflammation surrounding the tendon but caution is advised here.

4. Immobilisation

A short leg cast is often used for about six to eight weeks. This lets the tendon rest and the swelling decrease. Different experts recommend different boots for this.


  • Avoid overusing the tendon to ensure it doesn’t tear or otherwise become injured.
  • Individuals who participate in high-impact sports like tennis, basketball or soccer tend to have tears in the tendon from repeatedly using it.
  • Once your tendon has become inflamed, the pain can become chronic. You must work with a respected therapist to stop the chronicity and then the healing can occur.
  • If you are overweight, try losing a few pounds to help alleviate the pressure on the foot.
  • Women and individuals over 40 years of age are more at risk to the development of this syndrome.