Posterior Tibial Tendon Dysfunction
Specialist Physiotherapy for Inner Ankle Tendon Pain and Arch Collapse
Book your foot and ankle specialist appointmentPosterior tibial tendon dysfunction is a common cause of pain along the inside of the ankle and foot, often accompanied by gradual flattening of the arch. Symptoms frequently develop slowly and may begin as mild discomfort during walking before progressing to weakness, instability or visible changes in foot shape.
At Solent Specialist Physiotherapy, management focuses on early diagnosis, restoring tendon load capacity and supporting long-term foot stability.
The posterior tibial tendon runs along the inside of the ankle and attaches into the midfoot. It plays a crucial role in supporting the arch and controlling foot movement during walking. With every step, it works to stabilise the foot as body weight transfers forward.
When loading demands exceed the tendonā€™s ability to adapt, the tissue can become reactive and painful. Without appropriate intervention, progressive weakness may contribute to arch collapse and altered walking mechanics.
Persistent posterior tibial tendon pain is rarely caused by inflammation alone. In most cases, it reflects reduced tendon load tolerance combined with mechanical strain during weight-bearing activity.
Why Does Posterior Tibial Tendon Dysfunction Develop?
Posterior tibial tendon dysfunction often develops gradually due to cumulative loading.
Risk factors may include prolonged standing, increased walking distance, changes in activity levels, footwear alterations, higher body weight or reduced calf and foot strength. Age-related tendon adaptation may also reduce the tissueā€™s ability to tolerate sudden increases in demand.
As the tendon becomes overloaded, it may thicken and become sensitive. If weakness progresses, the arch may gradually lower, increasing strain on the tendon further and creating a cycle of overload.
Early recognition is important because management becomes more complex once structural foot changes develop.
How Posterior Tibial Tendon Dysfunction Commonly Presents
Pain is typically felt along the inside of the ankle, often just behind the medial malleolus, and may extend into the arch of the foot.
Symptoms are commonly aggravated by prolonged walking, uneven surfaces or single-leg loading. Some individuals notice swelling along the inside of the ankle. In more advanced stages, flattening of the arch and outward drift of the heel may become visible.
Unlike plantar fasciitis, pain is not usually centred under the heel. Instead, discomfort is linked to weight-bearing and tendon strain.
Recognising these features allows differentiation from other causes of medial ankle pain.
Is It Really Posterior Tibial Tendon Dysfunction?
Inner ankle pain can also arise from deltoid ligament irritation, tarsal tunnel syndrome, stress injury or referred lumbar symptoms.
Specialist assessment focuses on tendon loading tests, single-leg heel raise performance, arch control and walking mechanics.
Accurate diagnosis is essential because early-stage tendon dysfunction responds well to structured rehabilitation, whereas more advanced deformity may require orthotic or surgical discussion.
Imaging: When Is It Necessary?
Posterior tibial tendon dysfunction is often diagnosed clinically.
Ultrasound may demonstrate tendon thickening or degeneration. MRI can provide additional detail if partial tearing is suspected or if symptoms fail to improve as expected.
Imaging findings are interpreted alongside clinical presentation. Structural change on scan does not always determine symptom severity or dictate immediate surgical referral.
Imaging is most useful in cases where progression is unclear or when surgical opinion is being considered.
Understanding Flare-Ups
Posterior tibial tendon symptoms commonly fluctuate depending on walking load.
Flares often follow increased standing time, longer walks, travel or activity on uneven terrain. During these periods the tendon may become more sensitive and swelling may increase.
A flare represents temporary tendon irritability rather than sudden structural deterioration.
Management focuses on temporarily modifying load while maintaining controlled strengthening to prevent further deconditioning.
Complete withdrawal from walking is rarely necessary and may delay recovery.
Injection Therapy for Posterior Tibial Tendon Dysfunction
Injection therapy is not routinely indicated for posterior tibial tendinopathy, as research suggests corticosteroid injection into or around load-bearing tendons may weaken tendon structure and does not address underlying mechanical insufficiency.
While short-term pain relief may occur in selected cases, injection does not restore arch support or tendon load capacity. For this reason, management prioritises progressive strengthening and mechanical support strategies rather than passive interventions.
Injection decisions, if ever considered, must be approached cautiously and within a broader clinical discussion.
How We Help Manage Posterior Tibial Tendon Dysfunction
At Solent Specialist Physiotherapy, management begins with detailed assessment of tendon loading behaviour, arch mechanics and calf strength.
Early rehabilitation focuses on reducing pain sensitivity while maintaining appropriate weight-bearing. Progressive strengthening targets the posterior tibial tendon, calf complex and intrinsic foot muscles to restore arch support.
Footwear advice and, where appropriate, orthotic guidance may support the tendon during recovery. As strength improves, rehabilitation advances toward dynamic loading and walking progression to restore long-term resilience.
Where symptoms fail to improve or structural progression is evident, imaging referral or discussion of surgical options may be considered within a structured management pathway.
Our aim is to restore durable tendon function and prevent progression rather than provide temporary symptom relief.
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Understanding Tendinopathy
Posterior tibial tendon dysfunction is one of several tendon conditions we treat. If you would like to understand more about how tendon pain develops and why progressive loading is central to recovery, you can read our overview on specialist physiotherapy for tendinopathy.
Frequently Asked Questions About Posterior Tibial Tendon Dysfunction
Is this the same as fallen arches?
Can this condition get worse if untreated?
Do I need orthotics?
Should I stop walking?
How long does recovery take?
Is surgery common?
Book a Specialist Foot and Ankle Assessment
If you are experiencing persistent inner ankle pain or symptoms suggestive of posterior tibial tendon dysfunction, specialist physiotherapy appointments are available at our Havant clinic.
Assessment focuses on accurate diagnosis, restoring tendon capacity and supporting long-term foot stability.
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Book Your Foot and Ankle Assessment