Tibialis Posterior Tendinopathy

Pain in the arch of the foot

What is tibialis posterior tendinopathy?

The tibialis posterior tendon comes down from back of the shin bone and down the inside of your foot, ending near the arch of the foot, hence its name tibia(lis) posterior.

The function of the tibialis posterior muscle and tendon is to support the arch of the foot when you walk, run or stand.

It is a powerful muscle and it acts as the principal invertor of the foot and also initiates elevation of the heel. When walking, the tibialis posterior acts with the intrinsic foot musculature and the lateral leg muscles to control the degree of pronation i.e. flattening of the foot and the distribution of weight through the foot joints.

When standing on one leg, the invertor action of tibialis posterior, exerted from below, helps to maintain balance by resisting any tendency to sway side to side.

The tibialis posterior is also important in the maintenance of the arch of the foot. In overweight individuals with pes planus (flat foot deformity), unaccustomed activity can result in inflammation and degeneration of the terminal portion of the tendon, which leads to elongation of the tendon and progressive collapse of the arch of the foot. As the excursion is so short, the muscle cannot compensate for the lengthening of its tendon, a failure that results in tibialis posterior tendonipathy.

What will I experience?

With tibialis posterior tendinopathy, you will likely experience pain in the arch of your foot when you walk for long distances especially in footwear without much arch support like a pair of slippers. Some might experience pain after running a certain distance especially if your shoes are not well supported.

In more severe cases, one might experience pain on the inside of your ankle where you might experience some swelling and pain at night, after a long day of walking. The onset of pain usually is gradual.

What causes tibialis posterior tendinopathy?

In most cases, one would report a sudden episode of increased walking or a start of a new activity like hiking or running or changing into a new pair of shoes. One might also report pain on the inside of the foot after a recent ankle sprain. Not uncommon, also, is one recovering from a recent episode of hip, knee or ankle surgery. As you begin to place more weight on the operated limb, your foot muscles might not be accustomed to the amount of weight you’re putting on it ‘suddenly’, hence causing pain in the foot.

How can Physiotherapy help with tibialis posterior tendinopathy?

The Physiotherapist will first do an examination of the foot and the lower limb to identify the impairments or deficits present.

Surprise surprise. One might realise that your hip muscles are not strong and hence, increasing the load on your foot, hence causing the tibialis tendon to be placed on stretch and thereby causing pain.

The Physiotherapist will then educate you on how to modify the movements which might be painful for now and will prescribe exercises to strengthen the muscles and tendons affected. Correct footwear to maintain good foot posture is crucial here and our in-house podiatrist will ensure that appropriate shoes are worn to reduce your pain.

Treatment may include but is not limited to:

Advise and education pertaining to your condition
Soft tissue therapy
Heat therapy
Electrotherapy
Dry needling
Shockwave therapy
Taping to offload the affected tendons
Movement training
Returning to sport training
Exercises for tibialis posterior tendinopathy might include exercises that addresse any deficits in your hip muscles, knee control, intrinsic foot muscles or calf strength or length
Podiatry