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Tibialis Posterior Tendinopathy is a common lower limb condition causing ankle pain that we treat at Podiatry Quest. It usually causes pain behind the back of the inner ankle which can extend down the inside of the foot near the arch.

Tibialis Posterior Tendinopathy

The calf comprises of a synergistic group of muscles that collectively facilitate standing and walking. The tibialis posterior tendon originates from the tibia, fibula, and interosseous membrane, runs behind the medial ankle, and inserts primarily on the navicular bone on the inside of our foot. This tendon helps to prevent excessive inward role of our foot and provides arch support.

What Factors Increase The Risk of Tibialis Posterior Tendinopathy?

Tibialis posterior tendinopathy can be influenced by various risk factors:

  1. Age: More common in middle-aged and older adults.
  2. Obesity: Increased body weight can put more strain on the tendon.
  3. Flat Feet (Pes Planus): People with flat feet are at a higher risk due to the increased demand on the tibialis posterior tendon to maintain the arch.
  4. Overuse: Repetitive activities that strain the tendon, such as running, walking, or standing for prolonged periods, can lead to tendinopathy.
  5. Previous Injury: History of ankle sprains or other foot injuries can contribute to the development of tendinopathy.
  6. Inflammatory Conditions: Conditions like rheumatoid arthritis can increase the risk.
  7. Diabetes: Diabetic patients may have an increased risk due to changes in tendon structure and healing capacity.
  8. Improper Footwear: Wearing unsupportive shoes can exacerbate the condition.
  9. Biomechanical Issues: Abnormal foot mechanics, such as overpronation, can stress the tendon.

Podiatry Treatment for Tibialis Posterior Tendinopathy

It is important to have this condition properly diagnosed by your podiatrist to ensure that the treatment is appropriate for you. There are a few other conditions that present in a similar manner to tibialis posterior tendinopathy but the treatment will be different. Optimal treatment will also vary based on the duration and severity of the condition as well as your age, physical health and activity levels.

Treatment of the acute or ‘pain dominant phase’ of the condition involves a combination of:

  • Rest from aggravating activities/sport which cause pain
  • Icing
  • Anti-inflammatory medication
  • Strapping – your podiatrist can show you how to strap your foot to help with tibialis posterior pain.
  • Correct footwear- a supportive shoe that provides adequate support to the foot is vital to ensure quick healing. This condition will often worsen when patients wear very flat and unsupportive shoes and this encourages the foot to roll inwards which stretches and increases load on the tibialis posterior tendon.

Exercises for tibialis posterior tendinopathy

Strengthening muscles and tendons around the area will be vital to managing pain and reducing the likelihood of this problem returning. However, exercising this tendon may not be appropriate at all stages of this condition. This highlights the importance of working with an expert like a Podiatrist to ensure that the exercise program is suitable for your current condition and specific needs. We can design a program that gradually builds strength such as non-weight bearing to full-loading exercises and function exercises like skipping or hopping.

Shockwave therapy

Shockwave therapy is an exciting treatment modality available at all Podiatry Quest Clinics.  This treatment uses non-invasive high frequency shockwaves to stimulate repair of the injured tendon.

A recently published case series in the Journal of Foot and Ankle Surgery looked at the success of shockwave therapy in the treatment of chronic tibialis posterior tendinopathy in patients who had been unresponsive to other forms of treatment. This study found that a combination of radial shockwave therapy and foot exercises resulted in a clinical improvement in 90% of patients improving their activities of daily living.


A pair of custom foot orthotics is highly effective in the treatment of tibialis posterior tendinopathy. Your podiatrist will assess your foot function and structure to determine if you would benefit from a pair of custom foot orthotics.

The purpose of orthotics to manage tibialis posterior tendinopathy is to support the arch of the foot and to reduce load on this tendon.  This allows the tendon to heal adequately and also provide in-shoe offloading once the pain has subsided.

Not sure if you should see a Podiatrist?

Our Podiatrists are experts in heel pain who will diagnose your condition, assess the root causes of why you have it, and provide you with a specific management plan to solve your condition and keep you active.

If you would like to see our Podiatrists, please give us a call or book your appointment online! We look forward to helping you soon!

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