Posterior Tibial Tendonitis

Dysfunction of the posterior tibial tendon is a fairly common affliction of the foot and ankle, caused by inflammation or tearing of the tendon tissue. The condition can limit the tendon’s ability to provide support and stability to the foot arch, causing the feet to flatten. Posterior tibial tendon dysfunction can be treated without surgery.

Posterior Tibial Tendon Anatomy and Function

The posterior tibial muscle is located at the back of your lower leg, starting just below the knee and continuing into the foot and ankle, where its tendon attaches your calf muscle to the bones on the inside of your foot. Its main function is to provide support to the foot arch when walking or running.

During the loading phase of the gait cycle, the foot arch momentarily flattens or “pronates” to provide shock absorption as the posterior tibial muscle lengthens, setting the foot up for the propulsion phase. The posterior tibial tendon dictates the speed and magnitude of pronation, directly affecting the entire lower kinetic chain. Excessive pronation can cause damage to the posterior tibial tendon from overuse, leading to pain and dysfunction.


Posterior Tibial Tendon Tear Symptoms

Pain at the inside of the foot and ankle, sometimes but not always accompanied by inflammation.

Pain that worsens with physical activity, making high-impact activities like running and jumping nearly unbearable. Walking or standing may also cause pain.

Pain at the outside of the ankle due to displacement of the heel bone as the foot flattens during the gait cycle, placing pressure on the ankle.

Causes of Posterior Tibial Tendon Dysfunction

The tendon of the posterior tibial muscle can become damaged from overuse, usually brought on by repetitive and prolonged walking, running and jumping. Poor gait mechanics can also contribute to posterior tibial tendon strain.

Athletes, runners and fitness enthusiasts may be at higher risk of posterior tibial tendon injury and dysfunction. In non-athletic populations, women and people over age 40 have a higher incidence of posterior tibial tendon dysfunction. Being overweight or obese can increase the risk.


Diagnosis of Posterior Tibial Tendon Dysfunction

A health history and clinical exam followed by a simple calf raise test are common diagnostic tools for confirming posterior tibial tendon dysfunction. Other causes of pain must be ruled out, including ligament strains and sprains and arthritis.

At NYDNR, we use real-time diagnostic ultrasound to view the structures of the foot and ankle in motion, to accurately diagnose posterior tibial tendon dysfunction.

Posterior Tibial Tendonitis Treatment

At NYDNR, we go beyond treating pain to get to the source of tendon dysfunction, so we can correct it and restore healthy function. Some of our treatment methods include:

Gait analysis and retraining:

Faulty gait mechanics can be the root cause of posterior tibial dysfunction. NYDNR features the only motion analysis outpatient lab of its kind in NYC. 3D video motion capture and force plate technologies enable us to identify motor deficiencies throughout the gait cycle and quantify baseline joint angles and forces, so we can correct them.

ESWT (Extracorporeal Shock Wave Therapy):

Non-invasive high frequency shock waves can stimulate cellular repair of the posterior tibial tendon, promoting new cell growth and eliminating pain.

Foot Core Training:

Strengthening the intrinsic foot muscles that provide arch support and stability can reduce force loads placed on the posterior tibial tendon throughout the gait cycle.

The foot pain specialists at NYDNRehab are dedicated to helping you restore healthy foot function, so you can participate in the activities you love, without pain.

Our Awards


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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