Tibialis Posterior Tendinopathy


Tibialis posterior tendinopathy is an aggravation of the tibialis posterior tendon which runs from the shin (tibia and fibula), around the base of the medial maleolus (ankle bone) and into the tarsal bones of your foot. It’s main role in to maintain the arch of the foot, preventing over pronation and assisting with plantarflexion (raising up onto your toes). Typically damage occurs while preventing the eversion movement of the ankle (ankle rolling inwards) or the collapsing of the arch. If this is a sudden movement such as rolling your ankle in a hole in the ground then you may tear or rupture the tibialis posterior, a rupture will require surgery. If it is from a repetitive action such as running without the correct foot support then a tendinopathy may develop. The tibialis posterior plays an integral role in preventing the collapsing of the foot. Those of us with flat feet will typically have underactive or just weak tibialis posterior muscles. Strengthening these muscles will correct this.

Injuries may occur with:

  • Ankle sprains.
  • Poor foot biomechanics, typically a foot that over pronates i.e. arch collapses.
  • Altered foot biomechanics from higher up the kinetic chain such as your knees, hips or lower back (weakness and injury).
  • Excessive running on tight bends.


Signs and symptoms of tibialis posterior tendinopathy include:

  • Tenderness on palpation of the inside of your ankle.
  • Discomfort on palpating the muscles just inside your inner shin.
  • Tightness through your calf muscles.
  • Reduced dorsiflexion of your ankle (flexing your ankle).
  • Discomfort or tightness in the morning or after resting from running, jumping or other aggravating activities.
  • Condition tends to be one of gradual onset.


Physiotherapy treatments for tibialis posterior tendinopathy may include:

  • Specific massage techniques to relax the muscles and stimulate recovery of the tendons.
  • Assessment and modification of running technique.
  • Assessment of footwear.
  • Stretching the tibialis posterior.
  • Strengthening of the tibialis posterior muscle.
  • Strengthening to improve your ankle control.
  • Strengthening to regain your arch without the need for orthotics.
  • Strengthening of your lower back, hips, gluteal muscles or knees to improve control at your ankle.
  • Taping for support.
  • Prescribing orthotics if required.
  • Self mobilising or massage techniques.
  • Assessment and treatment of any other condition or compensatory movement that may be contributing to this condition.