Tibialis posterior dysfunction

What is tibialis posterior dysfunction?

Tibialis posterior dysfunction is a condition causing pain over the inside of the lower calf and ankle. It arises when the tibialis posterior tendon is unable to provide sufficient support to the arch of the foot.

It is often due to a tear or a generalised weakening and elongation of the tendon. Sometimes the tendon itself remains intact but the problem is caused by significant inflammation of the sheath which surrounds the tendon. In this case, the problem can be referred to as a tenosynovitis. Individuals with an inherently flat foot posture (which places the tibialis posterior under greater load) are particularly vulnerable to developing a tear or elongation to the tendon.

Common symptoms

Pain is located just behind and below the inside bone of your ankle which often tracks towards the inside arch of your foot. There may also be swelling and some individuals may experience a creaking (known as crepitus) with certain movements of the ankle.

Symptoms are aggravated with any activity which requires repeated use of the calf muscles for propulsion such as in walking and running. The arch of the foot may become flatter and the ankle may lean inwards.

How is a tibialis posterior dysfunction diagnosed?

Tibialis posterior dysfunction can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination. The main feature on examination is often pain and swelling over the tendon on palpation as well as pain when contracting the tibialis posterior muscle.

If there is a suspicion of a significant tear to the tibialis posterior tendon, your clinician may request an ultrasound scan to guide your management appropriately.

How is a tibialis posterior dysfunction treated?

Initial Management

It is usually necessary to rest, or at least reduce the amount of activity, for a short while to help the symptoms settle. Applying an ice pack for 5-15 minutes every 2-3 hours may provide some relief. You may wish you try over-the-counter painkillers such as paracetamol if needed.


Once the acute pain has settled, a tibialis posterior dysfunction can be managed effectively by adhering to the following advice and exercise routine to strengthen the tibialis posterior muscle and tendon.

3 x 15 repetitions 2x per day


You should ensure that you use well-fitting, supportive footwear with adequate arch support, both during your everyday activities and, particularly, during exercise. Very flat shoes and high heels can also exacerbate the problem. Orthotic inserts placed inside your shoes can ensure better foot position, which should prevent the problem recurring.

Further options

If there is a severe tear or rupture, total rest in a cast or boot may be required.

Surgical management

Surgical repair is occasionally considered in severe cases.