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Tibialis Posterior Pain

Tibialis Posterior Pain

A common foot injury is tibialis posterior pain. This condition can result in acquired flat foot and cause subsequent pain. The tendon can rupture, partially tear or become inflamed. The inside of the ankle can become quite painful.

Although the condition can be triggered by a direct trauma to the tibialis posterior tendon, such as a kick, it more frequently occurs over time with overuse and insufficient foot support. Foot pain is especially common in people who over pronate (where the foot rolls inwards) as this puts extra strain on the tendon.

Detailed Overview

It is really important that the tibialis posterior tendon functions correctly as it plays an essential role in providing arch support to the foot. If ignored, problems with the tibialis posterior tendon can progress into a full rupture, which will then require surgery to repair. Therefore pain or discomfort in the foot or heel area should never be ignored and treatment should be commenced as soon as possible.

A significant issue arising from untreated problems with the tibialis posterior is foot pain, fallen arches and acquired flat foot. This condition can lead to mobility problems, particularly in older people.

Signs and symptoms

Foot pain is felt on movement, especially when the foot is pushed downwards or the sole of the foot is flexed inwards.

The tibialis posterior tendon is attached to the navicular bone, located approximately where laces are tied. As well as the tendon itself, this area can also become extremely sore to touch. The area behind the inside ankle bone can become swollen and painful and will often make a distinctive 'creaking' noise when the ankle is moved.


Tibialis posterior dysfunction can be treated with PRICE in the early stages.

Protection – With a foot support

Rest – For the first 48 - 72 hours

Ice – Never applied directly to the skin

Compression – To reduce swelling

Elevation – elevating the affected area above the level of the to reduce blood flow and inflammation

It may be necessary to take Non-Steroidal Anti Inflammatory drugs (NSAIDs) or apply an anti-inflammatory gel to relieve pain and discomfort.

Very occasionally, where the condition is longstanding, an injection of local anaesthetic and corticosteroid, followed by a period of immobilisation, can reduce symptoms.

Unfortunately, because tibialis posterior tendon issues often occur as a result of abnormal mechanics of the lower leg, a physiotherapy assessment is usually required. Over pronation, or more rarely, a dysfunction of the ligaments supporting the inner foot, can cause overstrain of the tibialis posterior tendon. If this is the case, the sufferer can benefit from wearing a foot support or brace to reduce the stress on the tendon and increase mobility.

A strengthening programme may be recommended which, when carried out under the supervision of a physiotherapist can enable a safe and gradual return to previous activities.


Tibialis Posterior Dysfunction can occur when commencing a new programme of exercise. It can also develop when increasing the intensity or frequency of an activity. Therefore, care should be taken to plan a programme which includes rest breaks and gradual steps up in intensity.

Reduce the chances of developing problems with the tibialis posterior tendon by wearing supportive, good quality shoes.

For those with flat feet or fallen arches, orthotic footwear, foot support and/or inserts can relieve foot pain and excessive pressure on arches and tendons within the foot.