Tibialis Posterior Tendonitis:

What Is It and How Can I Treat It?

The Name of This Condition

This form of tendonitis is known by several different names. One alternate name is posterior tibial tendinitis. Another more appropriate name for this issue is tibialis posterior tendinopathy, but most people are familiar with the term tibialis posterior tendonitis.

What Is the Tibialis Posterior Muscle?

To understand this condition properly, you need to know about the tibialis posterior muscle. This muscle is located on the back of your lower leg. It starts below the knee and continues down into the ankle and foot. The muscle is connected to the bones of the foot thanks to the tibialis posterior tendon.

This muscle performs several functions. First, it helps your foot and ankle point towards the middle of the body. Second, the muscle allows you to point your foot forward. Third, the muscle helps preserve the arch of your foot. Fourth, it helps you walk, run, or perform any other activities that require you to put weight on your feet. May become damaged and result in tendonitis.

What is the function of tibialis posterior tendon?

Tibialis posterior tendon is:

  • Ankle plantar flexion and calcaneal inversion
  • A major dynamic supporter of the longitudinal arch of the foot
  • Functions as an eccentric controller of arch pronation
  • Compression stabilization of the first ray complex

What Causes Tibialis Posterior Tendonitis?

Usually, this tendonitis occurs due to overuse, foot type predisposition and poor gait mechanics. Repetitive or prolonged movements cause strain to the tendon. Usually, tendonitis results from a person who walks, runs, hops, or jumps too much. Strained tendons can also result from sports that require running or put pressure on the feet, such as football, skating, hockey and long-distance running.

What Factors Contribute to the Development of Tendonitis?

Intrinsic factors:

  • Flat foot deformity
  • Genetic makeup
  • Tarsal coalition

Extrinsic factors:

  • Rear foot valgus
  • Weak or tight hip musculature
  • Inability to move through frontal plane in the hip joints


  • Fractures
  • Osteoarthritis
  • Tear at the spring ligament


  • Women after forty tend to be the most affected


The combined function of tibialis posterior muscle and tendon is to control foot pronation. Pronation is a momentary flattening or folding movement of the mid-arch bones of the foot during loading response phase of gait (walking). This reaction serves three important functions:

  1. shock absorption
  2. starting eccentric function of posterior muscle group of the body during gait
  3. the success of resupination (another very important function of human gait responsible for propulsion phase) depends on timing and magnitude of pronation. Therefore resupination depends on function of tibialis posterior muscle tendon group.

The eccentric contraction of tibialis posterior tendon defines speed and magnitude of pronation and therefore directly affects function of the whole lower kinetic chain (ankle, knee, hip and low back joints). The excessive pronation places high demands on the tibialis posterior tendon that ultimately may lead to degeneration of the tendon due to excessive loading.


Clinical diagnosis is based on history, palpation and calf raise test.

Differential diagnosis

Following conditions may mimic tibialis posterior tendon dysfunction and should be differentiated by clinical examination, ultrasonography or MRI.

  • Sprain and strain of anterior portion of deltoid ligament
  • Attenuation of the fibers of spring ligament
  • subtlalar joint degenerative arthritis
  • talonavicular joint degenerative arthritis
  • lisfranc’s joint post traumatic degenerative arthritis

In order to avoid treatment for the wrong condition precise diagnosis is best way to deal with this type of injury. High-resolution diagnostic ultrasonography is readily available and is preferred. Another option is an MRI .

Tibialis posterior tendinopathy

Treatment of Tendonitis

The most effective way to treat tendonitis is to do gait retraining based on precise gait evaluation. You may have developed tendonitis because you move your legs and feet in a way that causes damage to your tendons. To see if you have a gait problem, you need a gait evaluation. This evaluation usually consists of having your feet filmed while you are running on an instrumental treadmill, which has a pixelated pressure platform. The pressure platform allows the best assessment of the gait cycle of the foot while video review allows seeing biomechanics of the whole body during walking. The feet should be filmed from front to back and side to side. There is no need to film your feet for a long period – a good software program can spot movement dysfunction within a minute or two.

The footage will be transferred to a computer and played in slow motion, and hopefully the program can determine if there is a problem with your gait. Once that is determined, you can start to correct your gait. It can take a lot of practice, and you may need to purchase new shoes, get an over-the-counter insole or have your doctor fabricate custom made orthotics to aid in the process, but it’s a worthwhile long-term investment.

Treatment at NYDNRehab

At NYDNRehab we are the ultimate place for gait analysis since we have the only outpatient motion analysis lab of this kind in NYC. We have established our own protocol of treatment of tibialis posterior dysfunction and tendinitis based on our own new and unique gait retraining methodology. The combination of this type of gait retraining and extracorporeal shock wave therapy leads to most positive outcomes. Tibilais posterior tendinosis should not be ignored as when its ignored or improperly treated it can develop into a very dangerous condition called PTTD (posterior tibial tendon dysfunction) which very frequently needs a very serious surgery.

When Can I Start Putting Pressure Back on My Feet?

You should only start exerting yourself again once several conditions are met. First, you should not experience any pain when you put pressure on your feet, and your ankle should have the full range of motion. You also need to make sure that you have appropriate footwear. Don’t jump right back into an intense training schedule; you need to slowly ease back into putting pressure on your feet.

On the first day that you are back on your feet, start with a 10-minute jog and make sure to rest afterwards. If that goes well, on the second day, try a 10-minute run and rest afterwards. You can increase your activity by 10 minutes or so each day until you reach prior levels of activity. If you start to feel pain, then you need to stop. Check to see if there is anything that you are doing that may be contributing to that pain. If necessary, start gait retraining again or visit the doctor. Do not keep running without considering the cause of the pain or you might find yourself back at square one – hobbling, limping, and sadly unable to move around.


The best prevention of tibialis posterior tendinitis is training eccentric function of tibialis posterior tendon.

Concentric strengthening is useless and may lead to foot muscle imbalance. Stronger and more mobile hips as well as strong foot intrinsic musculature are another way to avoid injuring tibialis posterior tendon. Consult your physical therapist, chiropractor or athletic trainer to prevent this condition.


What does successful treatment
of tendinopathy requires:

  • • Patient/athlete education
  • • Inflammation control if inflammation is present
  • • Regenerative treatment (ESWT)
  • • Gradual tendon strenghtening
  • • Loading optimisation (loading and unloading)
  • • Improvement in biomechanics and motor control
  • • Improvment in kinetic chain relationships
  • • Motor variability
  • • Landing or running mechanics
  • • Ergonomics
  • • Training errors
  • • Reversing sensory motor adaptation
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