Posterior Tibial Tendonitis

Is My Foot Pain Posterior Tibial Tendonitis?

by Mark Paigen 6 minute read

Your feet are complex. Each foot is made up of 26 bones, 30 joints and more than 100 muscles, tendons and ligaments. That's why nailing down the cause of your foot pain is best left to the medical professionals. But, if you're working on narrowing the list, ask yourself these questions to figure out if it could be Posterior Tibial Tendonitis.

The Basics ---

  • 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.

Shop Insoles

What You Need To Know ---

What Does The Posterior Tibial Tendon Do?

Of all the tendons in your foot, the Posterior Tibial Tendon plays an outsized role in your daily life. It runs from the calf muscle, down the inside of your ankle, and to the bones in your foot. It helps to stabilize your ankle, support your foot and hold up your arch when you walk.

Tendons like the Posterior Tibial Tendon can be injured suddenly or damaged slowly over time. In the case of the Posterior Tibial Tendon, an injury can be hugely disruptive to your activities because it is essential for walking. 

What Causes Posterior Tibial Tendonitis?

The most common causes for posterior tibial tendonitis are overuse and injury. Overuse can occur as a result of lots of running, intense exercise, sports training, or doing work that requires a lot of bending of the knees and ankles. Injuries usually stem from sudden activities like jumping, starting to sprint or a fall.

While overuse and injury are the cause of most posterior tibial tendonitis cases, there are other risk factors that could result in 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:

  • Overpronate. If your feet roll inward causing your arch to flatten out more than normal when you walk or run.
  • Have an injury. A tendon sprain or tear can lead to posterior tibial tendonitis.
  • Overuse the tendon. This can happen in sports like dancing, tennis, basketball and soccer as they require a lot of jumping, running, and repetitive impacts to the foot.
  • Are overweight. Extra body weight increases 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. High blood pressure puts you at higher risk.

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
  • Difficulty running or walking
  • 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
  • A gradual flattening of the arch

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.

    Who Treats Posterior Tibial Tendonitis?

    If you think you have posterior tibial tendonitis, it's time to visit a podiatrist. Expect a combination of physical examinations and imaging tests to 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. Depending on the severity of your tendonitis, your health care provider may recommend a combination of non-surgical and surgical treatments.

    Non-surgical Treatments

    Since surgery is a last resort for most people, there are several non-surgical treatments you can try to heal your tendon first:

    • Rest your foot and apply ice for 20 minutes at a time, several times a day
    • Work with a physical therapist
    • Add arch support insoles to your footwear
    • Use leg, foot, or ankle braces
    • Try non-steroidal anti-inflammatory medications for pain and swelling
    • Get cortisone injections to the tendon

    If non-surgical treatments don't help your symptoms after several months, your healthcare provider may advise surgery.

    Surgical Treatments

    Surgical intervention may be necessary if your symptoms do not respond to non-surgical treatment. However there are some risks. They include weakness of your calf muscles, nerve damage and continued pain in your foot and ankle. 

    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.

    How Long Is Recovery from Posterior Tibial Tendonitis Surgery?

    It may take up to a year before your pain subsides completely and full foot function returns. However, the earlier you address your tendon dysfunction, the better your post-surgical outcome will be. More severe cases will likely take longer to heal.

    During the healing process, you'll want to follow your healthcare provider's instructions about engaging in weight bearing activities with your leg and when to start a rehabilitation program. You'll likely be referred to a physical therapist to help in your healing process.

    Can Insoles Help Posterior Tibial Tendonitis?

    Addressing posterior tibial tendonitis early is the best way to avoid bigger issues later. Early intervention can reduce the damage to your foot and ankle and help you avoid surgery.

    Adding firm arch support insoles to your footwear can help correct biomechanical irregularities in your foot and limit the progression of your foot’s malfunction. By improving your foot position and raising your arch, insoles will relieve the stress and strain on your tendon.

    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. 

    Shop Insoles


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

    Back to blog