Tibialis posterior tendon pain is one of the more common causes of pain on the inside of the ankle, and it tends to build gradually rather than arrive all at once. The tibialis posterior tendon runs behind the bony bump on the inside of the ankle and plays a key role in supporting the arch of the foot. When this tendon is overloaded, it can become painful, swollen and weak, and the arch may begin to flatten over time. The good news is that, caught early, it usually responds well to the right rehabilitation.
In this guide we explain what tibialis posterior tendinopathy is, why it happens, how it is treated, and how to reduce the chance of it returning. If your ankle or arch has been aching, understanding the tendon involved is the first step. For persistent cases, shin, ankle and foot physiotherapy can help you build a clear plan.
What Is Tibialis Posterior Tendinopathy?
The tibialis posterior is a muscle deep in the lower leg whose tendon travels down behind the inside ankle bone and attaches under the foot. Its main job is to control the foot as it rolls in and to hold up the arch. Tendinopathy is the term for a tendon that has been overloaded to the point of pain and reduced capacity. When the tibialis posterior tendon is affected, the arch can lose some of its support, which is why the condition is sometimes linked with a developing flat foot.
What Causes This Tendon Injury?
Overload is the most common driver. Activities that repeatedly stress the tendon, such as running, hiking and dancing, can tip it past what it can tolerate, especially when training load rises quickly. A sudden ankle sprain or awkward landing can also injure the tendon, and the tissue naturally becomes a little less resilient with age. Body weight, footwear and foot posture can all add to the load the tendon has to manage. In most cases it is a combination of these factors rather than a single event.
Symptoms: Pain on the Inside of the Ankle
The classic symptom is pain and tenderness on the inside of the ankle, just behind and below the bony bump, sometimes spreading into the arch. Many people notice swelling in the same area, along with weakness and a feeling that the ankle is less stable than it used to be. Pain often worsens with walking, running or climbing stairs, and standing on tip-toes on the affected leg can be difficult. If the arch appears to be flattening or the foot is rolling inward more than before, it is worth having the tendon assessed.
How Tibialis Posterior Tendon Pain Is Treated
Treatment usually starts with a period of relative rest, which means reducing the aggravating load rather than stopping all activity. From there, progressive strengthening of the tibialis posterior and the surrounding calf and foot muscles is the core of rehabilitation, because tendons respond best to gradually increasing load. Orthotics or supportive footwear can help offload the arch while the tendon recovers, and taping or bracing may reduce strain in the early stages. Where appropriate, activity can be modified so you keep moving without flaring the tendon. A physiotherapist can tailor the loading programme to your stage and goals, and our tendinopathy physiotherapy is built around exactly this kind of graded rehabilitation.
How Long Does Recovery Take?
Tendons are slow to adapt, so patience matters. Many people improve over several months with consistent rehabilitation, though the exact timeline depends on how long the problem has been present and how much load the tendon needs to tolerate for your activities. Tendons can also be irritable, which means flare-ups are common along the way and are not a sign that things have gone backwards. Staying consistent with your programme is usually what makes the difference, and our guide on rest and exercise after a tendinopathy explains how to balance the two.
How to Prevent It Coming Back
Avoiding sudden spikes in training load is one of the most effective ways to protect the tendon, so build distance and intensity gradually rather than in large jumps. Regular ankle and foot strengthening keeps the tendon robust, and supportive, well-fitted shoes reduce unnecessary strain, particularly for runners. If you know you are prone to arch or ankle pain, keeping up a simple maintenance routine can help keep the tendon healthy between activity blocks.
Common Questions
What Does Tibialis Posterior Tendon Pain Feel Like?
It usually feels like a deep ache or sharp pain on the inside of the ankle, just behind the ankle bone, and can extend into the arch. It often worsens with activity such as walking, running or going up stairs, and the area may be swollen or tender to touch.
Do I Need Orthotics for a Fallen Arch?
Not everyone does. Orthotics or supportive footwear can help offload the tendon and support the arch while it recovers, but they work best alongside a strengthening programme rather than on their own. A physiotherapist can advise whether they are likely to help in your case.
Can I Keep Running With Ankle Tendon Pain?
Sometimes, in a modified form. Completely stopping is not always necessary, but running through significant pain can prolong the problem. Adjusting your distance, surface and frequency, guided by a physiotherapist, often lets you keep some running while the tendon settles.
When Should I See a Physiotherapist for Tibialis Posterior Pain?
It is worth booking in if the pain has lasted more than a week or two, is limiting your walking or running, or if you notice the arch flattening. Earlier assessment generally makes rehabilitation more straightforward.
How BeFit Can Help
At BeFit Training Physiotherapy, our physiotherapists assess and treat tibialis posterior tendinopathy and related foot and ankle injuries at both our Edgecliff and Coogee clinics. We work out how the tendon became overloaded, then build a progressive strengthening and loading programme around your activities, whether that is running, hiking or simply walking comfortably again. Every initial consultation runs for forty-five minutes, one-on-one, with a thorough assessment and a clear explanation of what we find. We support active people across Sydney’s Eastern Suburbs, and no referral is required to book.
Book an appointment at BeFit Training Physiotherapy — no referral needed.
Edgecliff: (02) 9327 7749 | Coogee: (02) 7205 2805 | befittrainingphysio.com/book-now
Related Services
Learn more about our shin, ankle and foot injury physiotherapy, tendinopathy treatment and running assessment in Sydney.
Further Reading
If you are working through a tendon problem, you may also find these helpful: How to Know if It’s Tendinopathy or Tenosynovitis and How to Recover Faster: Rest and Exercise After a Tendinopathy.
References
Ross MH, et al. Exercise for posterior tibial tendon dysfunction: a systematic review. J Foot Ankle Res. 2018.
Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009.
Kulig K, et al. Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise. Phys Ther. 2009.
Australian Physiotherapy Association. Clinical guidelines. physiotherapy.asn.au.
