What is Tibialis Posterior Dysfunction?

The Tibialis Posteior tendon serves as one of the major supporting structures of the foot, helping stabilisen the arch and help the foot to function while walking. A tendon attaches muscle to bone and the Tibialis Posterior tendon attaches the calf muscles to the bones on the inside of the foot.

Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in this tendon, impairing its ability to support the arch. Overuse of the posterior tibial tendon is often the cause. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.This results in flattening of the arch of the foot.

Signs and Symptoms

Symptoms may include pain and swelling along the length of the tendon around the ankle, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change.

For example, when Tibialis Posterior Dysfunction initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen. Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As Tibialis Posterior becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.


A conservative approach to treating Tibialis Posterior Dysfunction is first recommended. This will involve rest and immobilisation with a sports boot to allow the tendon to heal, supportive footwear, stretching and strengthening exercise programs and custom orthotics to support the arch and allow the tendon to function without be overloaded.

In cases of Tibialis Posterior Dysfunction that have progressed substantially or have failed to improve adequately with non-surgical treatment, surgery may be required. For some advanced cases of Tibialis Posterior Dysfunction, surgery may be the only option.

Surgical treatment may include repairing the posterior tibial tendon, realigning the bones of the foot, or both. Your podiatrist will refer you to a foot and ankle surgeon who will determine the best approach for your specific case.