If you have nagging pain along the inside of your ankle or arch, especially when walking or standing for a while, you might assume it is plantar fasciitis. But there is another common and often-missed cause worth knowing about, the tibialis posterior tendon.
This tendon runs behind the inside of your ankle and helps hold up the arch of your foot. When it becomes painful or dysfunctional, it can cause inner-ankle and arch pain and, over time, a gradually flattening arch. Here is what tibialis posterior tendinopathy is, why it is so often overlooked, what helps, and when to see a podiatrist.
- What is the tibialis posterior tendon?
- Why is it so often missed?
- What are the symptoms?
- What causes tibialis posterior problems?
- What helps tibialis posterior tendinopathy?
- When should you see a podiatrist?
- Helping You Perform at Your Best
What is the tibialis posterior tendon?
The tibialis posterior is a muscle whose tendon runs down the back of the lower leg, behind the bony bump on the inside of your ankle, and attaches under the arch of your foot. Its job is to help support the arch and control the foot as you walk and run. When this tendon is overloaded or irritated, it can become painful, a condition often called tibialis posterior tendinopathy or, when the tendon is not doing its job well, posterior tibial tendon dysfunction.
Left unaddressed over time, ongoing dysfunction can contribute to a gradually flattening arch, sometimes described as adult-acquired flatfoot. The encouraging news is that many people respond well when it is picked up and loaded appropriately.
Why is it so often missed?
Because foot pain is so commonly blamed on plantar fasciitis, tibialis posterior problems can slip under the radar. In a UK study, symptomatic posterior tibial tendon dysfunction was reported in about 3.3 percent of women over the age of 40, and notably the condition was frequently under-recognised despite characteristic and prolonged symptoms. Adult-acquired flatfoot is reported in up to 10 percent of people over 40 and is more common in women.
The key difference is location. Plantar fasciitis pain is usually under the heel, whereas tibialis posterior pain is along the inside of the ankle and arch. Getting the right diagnosis matters because the management is different.
What are the symptoms?
Typical features of tibialis posterior tendinopathy include:
- Pain and tenderness along the inside of the ankle and arch
- Discomfort that is worse with walking, standing or activity
- Sometimes swelling along the inner ankle
- A feeling that the arch is flattening or the foot is rolling in
- Difficulty doing a single-leg heel raise on the sore side
If you notice a progressively flattening arch, increasing difficulty walking, or the foot rolling inward more over time, it is worth getting assessed sooner rather than later.
What causes tibialis posterior problems?
Like many tendon issues, it is often an overload problem, where the tendon is asked to do more than it can currently handle. Contributing factors can include a rapid increase in walking or running, being over 40, higher body weight, and conditions such as diabetes or high blood pressure. It is more common in women and the risk rises with age.
What helps tibialis posterior tendinopathy?
Most people are managed without surgery, particularly when it is caught early. A typical approach includes:
- Adjusting aggravating loads while keeping you moving
- Progressive strengthening for the tibialis posterior and calf, such as graded heel raises
- Supportive footwear, and sometimes orthoses, to support the arch while the tendon settles
- A gradual return to walking, standing tasks and sport
Many people improve with a structured loading and support plan tailored to their foot and goals. A podiatrist can assess the arch, footwear and loading and build a plan that fits your daily activity.
When should you see a podiatrist?
See a podiatrist if you have persistent inner-ankle or arch pain, notice your arch flattening, or your foot pain is not settling with rest. Early assessment helps confirm the cause, rule out other issues and start the right loading and support plan before things progress.
Helping You Perform at Your Best
Inner-ankle and arch pain can be frustrating, especially when it affects your walking, work and the activities you enjoy.
At Ace Sports Medicine in Upper Mount Gravatt, our podiatrists provide personalised care for foot and ankle pain across Brisbane’s southside, from settling symptoms to footwear, support and a graded loading plan. Your first appointment includes an assessment and a starter plan so you know your next step.
Need support for arch or inner-ankle pain? Book an appointment with the Ace Sports Medicine team today.