Is My Foot Pain Posterior Tibial Tendonitis?

Posterior Tibial Tendonitis

There are lots of tendons in your feet and legs, but one of the most important is the posterior tibial tendon. It links the calf muscle to the bones on the inside of the foot. It has a big job, so when it becomes inflamed or injured, your daily live is impacted in a big way. 


  • Posterior tibial tendonitis is the inflammation of the posterior tibial tendon, which connects the calf muscle to the bones on the inside of the foot. Often caused by a tendon sprain or tear, it is more common in women and people over 40.
  • Symptoms of posterior tibial tendonitis include redness, swelling or pain on the inner arch, heel or ankle and foot pain that increases with running, jumping or climbing.
  • To be sure of your diagnosis, see a medical professional for an examination and appropriate course of treatment.
  • We recommend the firm support of Tread Labs Pace insoles to help correct the biomechanical irregularities that can lead to posterior tibial tendonitis.



Where Does Posterior Tibial Tendonitis Hurt?

Since the posterior tibial tendon links your calf muscle to the bones on the inside of your foot, if you have posterior tibial tendonitis, you can expect to feel pain around your inner foot and ankle. 

Other common symptoms include:

  • Redness, swelling, or pain on the inner arch, heel, or ankle
  • Redness, swelling, or pain on the outer ankle or back of heel
  • Increasing foot pain with activities, particularly high-impact activities like running, jumping, or climbing
  • Foot pain after long periods of standing or walking a short distance

You definitely don't want to ignore or push through any posterior tibial tendonitis symptoms you're having as they can lead to progressive damage to the tendon and cause your foot’s arch to fall. That can result in flat-footedness or require surgical intervention to correct. If you have inner arch, heel or ankle pain, you'll want to visit a medical professional for a diagnosis.

What Causes Posterior Tibial Tendonitis?

While the most common causes of posterior tibial tendonitis are injuries and overuse, there are other reasons you can end up with posterior tendon dysfunction. From weight to age and gender to blood pressure, risk factors can play a role in whether or not you end up sidelined. 

You're at a higher risk for posterior tibial tendonitis if you:

  • Have an injury. A tendon sprain or tear can lead to posterior tibial tendonitis.
  • Overuse the tendon. Participating in sports that require a lot of jumping, running, or repetitive impacts to the foot can increase risk.
  • Are overweight. Overweight and obese people are at higher risk due to increased stress on the tendon.
  • Are older. Posterior Tibial Tendonitis is more common in people over 40.
  • Are female. Women are more likely than men to develop the condition.
  • Have hypertension. Those with high blood pressure are at higher risk.

Who Treats Posterior Tibial Tendonitis?

If you think your foot pain is caused by posterior tibial tendonitis, it's time to visit a podiatrist for a diagnosis. During your appointment, you can expect a combination of physical examinations and imaging tests that will determine if you have the condition.

Physical Examination

When examining your foot and leg, your doctor will look for symptoms like:

  • Lower leg and ankle swelling, especially along the tendon
  • A change in the shape of your foot, such as a collapsing arch
  • An outward turning heel, with the toes askew from the ankle

Your doctor might ask you to stand on one leg and rise to your tiptoe. If you have trouble doing this, or you have inflexibility in your ankle, it could be a sign of posterior tibial tendonitis.

Imaging Examination

Your doctor may also order imaging to take a closer look at what is going on inside your foot:

  • X-Rays of the bones can rule out other issues like arthritis, a fracture, or problems with bone density.
  • Magnetic Resonance Imagery (MRI) lets your doctor observe your muscles, tendons, and soft tissues to see if there is evidence of tendonitis.
  • CT Scans will provide a cross-sectional view of your foot and help your doctor differentiate conditions like arthritis and tendonitis, making a clear diagnosis easier.
  • Ultrasounds can provide a definitive imaging analysis.

Will Posterior Tibial Tendonitis Go Away?

It can take between 6 to 9 months (or longer) for your posterior tibial tendonitis symptoms to improve and your tendon to heal. Immobilizing your foot as much as possible is the most helpful thing you can do to heal. Depending on the severity of your tendonitis, your health care provider may recommend a combination of nonsurgical and surgical treatments.

Nonsurgical Treatments

Before resorting to surgery, there are several treatments you can try to heal your tendon:

  • Rest your foot and apply ice for 20 minutes at a time, several times a day
  • Physical therapy
  • Adding arch support insoles to your footwear
  • Leg, foot, or ankle braces
  • Non-steroidal anti-inflammatory medications for pain and swelling
  • Cortisone injections to the tendon

Surgical Treatments

Surgical intervention may be necessary if your symptoms do not respond to non-surgical treatment. Depending on the location and level of damage to your tendon, your surgeon may consider one of the following procedures:

Lengthening the Achilles Tendon (Gastrocnemius Recession)

For those unable to lift their ankle, this surgery increases the calf muscle span and may prevent the recurrence of flat footedness. Possible complications include damage to the nerves, muscle weakness, and difficulty going up stairs or pushing up to the toes.

Tendon Cleaning (Tenosynovectomy)

For early stages of posterior tendonitis that do not respond to non-surgical types of treatment, this surgery involves removal of the damaged or inflamed tissue around the tendon.

Tendon Transfer

Your surgeon may replace the damaged tendon with a functioning tendon from another part of your foot if you suffer from flexible flatfoot. If the tendon is not too degraded, they may fuse it to a functioning tendon to create additional support and function.

While this surgery can restore function to the posterior tendon, it will most likely cause a disruption elsewhere in the foot, and you may not be able to run, jump, or participate in other athletic activities post-surgery.

Joint Fusion

When you have flat-footedness and stiffness caused by arthritis, your surgeon may perform arthrodesis (fusion) of the foot joints to create a better foot alignment. Damaged or healthy cartilage may be removed and replaced with a temporary metal plate and screws until new tissue bonds the bones and your foot heals.

Complications include a loss of side-to-side motion in the foot post-surgery, but your up-and-down motion and pain may improve. If the bones do not properly knit together, you may need a second surgery.


This surgery involves cutting and relocating bones in your foot to stabilize your arch. Depending on the severity of your condition, you may require a bone graft and temporary plates and screws to lengthen your heel.

Posterior Tibial Tendonitis Post-Surgery

Even with a successful surgical outcome, it may take up to one year before your pain subsides completely and full foot function returns. Generally, the earlier you can address your tendon dysfunction, the better and quicker your post-surgical outcome will be. More severe cases of flat-footedness and those with limited foot function prior to surgery will likely take longer to heal.

Do Insoles Help Posterior Tibial Tendonitis?

The best thing you can do to reduce damage to your foot and ankle from posterior tibial tendonitis is to make changes as early as possible. That includes adding arch support insoles to your footwear. They're often recommended as a non-surgical treatment to help correct biomechanical irregularities in your foot and limit the progression of your foot’s malfunction.

When you're looking for insoles to help with posterior tibial tendonitis, you'll want to find ones with firm support. Drugstore inserts won't provide the structure your feet need to correct your biomechanics. Also make sure the arch support of your insoles matches the contours of your foot. Your feet aren't one-size-fits-all, and your insoles shouldn't be either.

The bottom line is to make sure you take care of your feet so they stay healthy and pain-free. That will keep you doing all the things you love for a lifetime. 



Questions? Drop us a line at We're here to help.

Mark Paigen
Mark Paigen

Mark has always believed exceptional footwear can change lives. He's been in the footwear industry for over 30 years, working with podiatrists, pedorthists, foot care experts, and footwear makers. Mark started Chaco sandals in 1989 and developed a game-changing sport sandal that delivered comfort and durability. After Chaco sold in 2009, Mark ultimately started Tread Labs to continue transforming people's footwear so they can walk better, feel better, live better.

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