What Is Posterior Tibial Tendonitis? A Complete Guide

If you’re experiencing pain on the inner side of your ankle or foot, you may be dealing with posterior tibial tendonitis. This condition is more common than you might think, affecting millions of people each year—particularly athletes and those on their feet for extended periods.

Understanding the Posterior Tibial Tendon

The posterior tibial tendon (PTT) is one of the most important tendons in your lower leg. It connects the posterior tibial muscle to the bones on the inside of your foot. This tendon plays a crucial role in:

  • Supporting the arch of your foot
  • Stabilizing your ankle during walking
  • Inverting the foot (turning it inward)
  • Helping you push off when walking or running

When this tendon becomes inflamed or irritated, it can lead to posterior tibial tendonitis—a painful condition that can significantly impact your mobility if left untreated.

What Causes Posterior Tibial Tendonitis?

Posterior tibial tendonitis occurs when the tendon becomes inflamed, usually due to overuse or repetitive stress. Several factors can contribute to developing this condition:

Common Risk Factors

  • Overuse from high-impact activities (running, hiking, sports)
  • Age (most common between ages 40-60)
  • Flat feet (pes planus) that put extra stress on the tendon
  • Obesity or sudden weight gain
  • Improper footwear that doesn’t provide adequate arch support
  • Trauma or acute injury to the ankle
  • Diabetes or other conditions affecting circulation

Repetitive Strain

The most common cause is repetitive strain from activities that involve repeated ankle flexion and inversion. This includes:

  • Running (especially uphill)
  • Walking on uneven surfaces
  • Sports requiring quick direction changes
  • Prolonged standing or walking

Symptoms of Posterior Tibial Tendonitis

Recognizing the symptoms early can help you seek treatment before the condition worsens. Common symptoms include:

Primary Symptoms

  1. Pain along the inner ankle and foot — This is the hallmark symptom. Pain is typically felt behind the medial malleolus (the bony bump on the inside of your ankle).

  2. Swelling and warmth — The area around the tendon may become swollen, tender, and warm to the touch.

  3. Redness — Inflammation may cause visible redness over the affected area.

  4. Pain with activity — Pain usually worsens with weight-bearing activities like walking, standing, or climbing stairs.

  5. Weakness — You may notice weakness in the ankle, especially when trying to rise on your toes.

Advanced Symptoms

If left untreated, posterior tibial tendonitis can progress, leading to:

  • Flattening of the arch (acquired flatfoot)
  • Chronic ankle instability
  • Difficulty walking or standing for long periods
  • Radiating pain up the leg

How Is Posterior Tibial Tendonitis Diagnosed?

If you suspect you have posterior tibial tendonitis, it’s important to see a healthcare professional for an accurate diagnosis. The diagnostic process typically includes:

Physical Examination

Your doctor will:

  • Examine your foot and ankle for swelling and tenderness
  • Test your range of motion and strength
  • Check for flatfoot or arch collapse
  • Observe your gait (how you walk)

Imaging Tests

  • X-rays: To rule out fractures or arthritis
  • MRI: To assess tendon damage and inflammation
  • Ultrasound: To visualize tendon tears or inflammation

Treatment Options for Posterior Tibial Tendonitis

The good news is that posterior tibial tendonitis often responds well to conservative treatment. The earlier you seek treatment, the better your chances of recovery.

Non-Surgical Treatments

1. Rest and Activity Modification

  • Avoid activities that aggravate the pain
  • Switch to low-impact exercises (swimming, cycling)
  • Use crutches if needed to reduce weight-bearing

2. Ice Therapy

  • Apply ice packs to the affected area for 15-20 minutes, 3-4 times daily
  • Always wrap ice in a towel to protect your skin

3. Medications

  • NSAIDs: Over-the-counter anti-inflammatories like ibuprofen can reduce pain and swelling
  • Always consult your doctor before starting any medication

4. Physical Therapy

A physical therapist can help with:

  • Specific exercises to strengthen the posterior tibial muscle
  • Stretching exercises to improve flexibility
  • Gait training and balance exercises
  • Ultrasound or electrical stimulation therapy

5. Orthotics and Supportive Footwear

  • Arch supports: Custom or over-the-counter orthotics can provide additional support
  • Supportive shoes: Avoid flat shoes; choose footwear with good arch support and stable heels
  • Ankle braces: For severe cases, a brace may help stabilize the ankle

6. Corticosteroid Injections

In some cases, a doctor may recommend corticosteroid injections to reduce severe inflammation. However, these are typically used sparingly due to potential side effects.

When Is Surgery Necessary?

Surgery is usually considered only when conservative treatments fail after several months. Surgical options include:

  • Tendon repair: Removing damaged tissue and repairing the tendon
  • Tendon transfer: Using a nearby tendon to replace the damaged posterior tibial tendon
  • Osteotomy: Cutting and realigning bones to relieve pressure on the tendon
  • Fusion: fusing bones together in severe, chronic cases

Recovery and Prevention

Recovery Timeline

With proper treatment, most people with posterior tibial tendonitis see significant improvement within 6-8 weeks. However, full recovery can take 3-6 months depending on the severity of the condition.

Prevention Tips

To reduce your risk of developing posterior tibial tendonitis:

  1. Wear supportive shoes — Choose footwear with proper arch support
  2. Increase activity gradually — Avoid sudden increases in exercise intensity
  3. Strengthen your muscles — Regular exercises to strengthen your calves and foot muscles
  4. Maintain a healthy weight — Reducing stress on your tendons
  5. Listen to your body — Don’t ignore persistent ankle pain
  6. Stretch regularly — Especially before and after exercise

Posterior Tibial Tendonitis vs. Posterior Tibial Tendonosis

It’s important to note that posterior tibial tendonitis and posterior tibial tendonosis are related but distinct conditions:

  • Tendonitis refers to acute inflammation of the tendon
  • Tendonosis refers to chronic degeneration of the tendon due to long-term overuse

Both conditions cause similar symptoms but require slightly different treatment approaches. We’ll explore this difference in more detail in our upcoming article on posterior tibial tendonitis vs. tendonosis.

When to See a Doctor

Seek medical attention if you experience:

  • Persistent pain that doesn’t improve with rest
  • Significant swelling or redness
  • Difficulty walking or bearing weight
  • Pain that worsens despite conservative treatment
  • A popping sensation followed by sudden pain (possible tendon rupture)

Conclusion

Posterior tibial tendonitis is a manageable condition, especially when caught early. Understanding the causes, recognizing symptoms, and seeking prompt treatment can help you return to your normal activities quickly.

If you’re experiencing symptoms of posterior tibial tendonitis, don’t wait—consult a healthcare professional to get an accurate diagnosis and appropriate treatment plan.

Ready to learn more about how posterior tibial tendonitis differs from tendonosis? Read our comprehensive comparison guide next.