Posterior Tibial Tendon Dysfunction

Posterior tibial tendon dysfunction occurs when the posterior tibial tendon becomes inflamed or torn and may not be able to provide stability and support for the arch of the foot – which can result in a flatfoot. It is one of the more common causes of adult acquired flatfoot deformity.

a foot with posterior tibial tendon dysfunction

Some common symptoms of posterior tibial tendon dysfunction include:

  • Pain along the inside of the foot and ankle that may or may not be associated with swelling in the area
  • Pain that gets worse with activities which makes it difficult to walk or stand for long periods of time
  • Pain on the outside of the ankle that is caused by the heel bone shifting to a new position outward, putting pressure on the outside ankle bone 



An acute injury, such as a fall, can result in the posterior tibial tendon tearing or cause it to become inflamed. The tendon can also tear due to overuse from high-impact sports, such as basketball, tennis, or soccer. The arch will then slowly collapse over time, resulting in a flatfoot deformity. 


Posterior tibial tendon dysfunction is more common in women and people older than 40 years of age, where there is underlying degeneration (tendinosis) of the tendon. Other risk factors include obesity, diabetes and hypertension.


Your orthopaedic specialist will start off by asking about your medical history, followed by a physical examination to check your foot and ankle to look for any swelling, change in the shape of the foot, especially the foot arches, and range of motion of the foot joints. 


You may also be required to undergo an X-ray, MRI or CT scan, or ultrasound for an accurate diagnosis. This will help to determine if the posterior tibia tendon is torn, and if there is underlying arthritis in the foot joints.


Symptoms of posterior tibial tendon dysfunction can typically be relieved with non-surgical treatments such as resting, applying ice, and taking nonsteroidal anti-inflammatory medications. A short period of immobilisation with a short leg cast or walking boot will allow the tendon to rest and heal. Assistive devices, such as a brace to support the hindfoot, or a shoe insert (orthotic) may be used to provide arch support, and to offload pressure points within the foot. Physical therapy helps to strengthen the tibialis posterior muscle and maintain mobility of the foot and ankle joints. 


If conservative treatments prove to be ineffective after 6 months, your orthopaedic specialist may recommend surgery. This can be soft tissue procedures to lengthen the calf muscles so as to improve ankle movement, debride and remove inflamed tissue around the tibialis posterior tendon, or a tendon transfer to reroute another tendon from the foot to replace the function of the torn posterior tibia tendon. In more severe deformities, bony correction (osteotomy) to cut and shift the hindfoot bones to recreate the foot arch may be required. If significant arthritis has already set in, your surgeon may choose to perform fusion, i.e., to remove damaged cartilage and bone of the joints in the foot and to fix them together.


Every case is different; hence it is best to consult an orthopaedic specialist for an accurate diagnosis so that you can obtain the best treatment option that is most suitable for you. Reach out to us today if you suspect you are suffering from posterior tibial tendon dysfunction and let us help you enjoy a better quality of life.