What is it? 

Tibialis posterior tendonitis (tendinopathy) is an overuse injury causing pain on the inside of the ankle. Pain is felt on the inside of the ankle which may radiate under the arch of the foot.

What is the cause? 

Athletes who overpronate are at increased risk. This is because there is more strain on the tibialis posterior muscle. As a result, it repeatedly overstretched and overworked. Sports and activities that increase the risk of tibialis posterior tendinopathy are those requiring prolonged stretching of the tibialis posterior muscle. For example:

• Ballet dancing

• Ice skating

• Sprinters who run a lot on tight bends

Long-term injuries to the tibialis posterior result in insufficiency of the muscle and a condition called tibialis posterior dysfunction (PTTD) which results in fallen arches, or flat feet.

There is sometimes confusion between PTTD and tibialis posterior tendinopathy and the terms are often used interchangeably. However, these conditions are slightly different as PTTD is a dysfunction of the muscle and tendinopathy is a degeneration of the tendon.

Signs & Symptoms

• Pain on the inside of the ankle, specifically behind the medial malleolus. This is the bony protrusion on the inside of the ankle.

• Pain comes on gradually over time.

• Symptoms may also radiate along the length of the tendon as it passes under the foot.

• A creaking sensation is called crepitus during movement.

What can we do about it? 

Orthotics and exercises have been found to be particularly effective in the management of tibialis posterior tendinopathy. Relative rest, activity modification and deep tissue release of the tibialis posterior muscle can be used as part of a treatment plan.