Causes, Symptoms and Treatment for Posterior Tibial Tendonitis

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The feet are used continuously and support a large load and several types of movement. Hence tendonitis in the foot is a common problem. One of the most commonly affected tendons in the foot and ankle is the posterior tibial tendon.

Anatomy of the Ankle

The ankle joint is supported by several tendons. The large Achilles tendon which attaches the calf muscles to the calcaneus or heel bone is the most important for walking, running and jumping. The posterior tibial tendon attaches to one of the smaller calf muscles at the back of the leg and runs beind the inside part of the ankle bone to the underside of the foot. This tendon is important in supporting the arch of the foot and turning the foot inward. The tibia is one of the two long bones that make up the lower leg.

Causes of Tendonitis

Tendonitis occurs when a tendon becomes inflamed and may be due to a variety of conditions or injuries, including too much exercise, not warming up properly before exercise, a lack of movement and repeat strain and motions of the same area. Posterior tibial tendonitis can occur from repetitive strain, improper support from shoes, improper style of walking (usually on the innermost portion of the feet), injury or trauma to the leg or foot and from arthritis. Aging and normal wear and tear also causes some loss of elasticity in the fibers of the tendon which can cause some discomfort during excess physical activity.


Tendonitis of the posterior tibial tendon causes pain in the instep (inner area) of the foot and swelling and inflammation along the tendon’s path. In very severe cases where inflammation of this tendon causes it to rupture, a flattening of the foot’s arch may occur.


Posterior tibial tendonitis is normally diagnosed with a physical examination by a doctor. An MRI scan may be required to confirm diagnosis and see whether the tendon is intact or ruptured.


Treatment for a mild case of posterior tibial tendonitis includes extra support with a firm arch support that is inserted in the shoe. The arch support takes some of the strain off the tendon and allows the tendon to heal. For more severe cases, rest is required, along with anti-inflammatory medications. In very rare cases when all other treatment fails, surgery may be required.