Posterior Tibial Tendon Dysfunction

The posterior tibial tendon runs along the inside of the ankle and foot and plays an important role in supporting the arch and controlling foot movement during walking and running. It helps the foot remain stable while allowing efficient transfer of load through the lower limb.

Posterior tibial tendon dysfunction occurs when this tendon becomes irritated or unable to tolerate the loads placed upon it. Despite often being described as an inflammatory condition, symptoms are more commonly related to reduced tendon capacity, strength deficits, and altered foot mechanics over time. As the condition progresses, the arch of the foot may gradually lower, placing additional strain on the tendon and surrounding structures.

• Pain or tenderness along the inside of the ankle or arch

• Swelling along the posterior tibial tendon

• Pain with walking, running, or prolonged standing

• Reduced ability to perform a single-leg heel raise

• A feeling of weakness or fatigue in the foot or ankle

• Gradual flattening of the arch or change in foot shape

• Symptoms that worsen with increased activity

• Sudden increases in walking, running, or standing load

• Reduced strength of the calf, foot, and ankle muscles

• Limited ankle mobility or stiffness

• Altered foot mechanics or reduced arch support during movement

• Inadequate recovery between loading sessions

• Previous foot or ankle injury

• Prolonged time spent weight-bearing on hard surfaces

Physiotherapy for posterior tibial tendon dysfunction focuses on improving the tendon’s ability to tolerate load and restoring strength and control of the foot and ankle. Because symptoms are often related to reduced tissue capacity rather than inflammation alone, treatment emphasizes progressive strengthening and gradual loading rather than prolonged rest.

Physiotherapy management may include:

• Progressive strengthening of the calf, posterior tibial tendon, and intrinsic foot muscles

• Exercises to improve arch control and lower limb alignment

• Gradual loading of the tendon to improve tolerance to walking and running

• Mobility work for the ankle and surrounding joints when indicated

• Movement retraining to reduce strain on the medial foot and ankle

• Activity and load management to support recovery while maintaining mobility

• Footwear, taping, or orthotic guidance when appropriate

Recovery timelines vary depending on symptom duration, structural changes, and activity demands. Many individuals experience meaningful improvement over weeks to months with a structured, progressive rehabilitation program. Early management can help reduce symptom progression and support long-term foot function.