Matt Wettstein, DPM
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Experienced podiatrist specializing in all foot care including wound care and sports medicine in Twin Falls.

podiatrist examining painful flat foot | Experienced Twin Falls PodiatristPosterior tibial tendinitis is a condition characterized by inflammation or irritation of the posterior tibial tendon. This tendon is located on the inside of the ankle and plays a crucial role in supporting the arch of the foot and maintaining proper foot and ankle alignment. Consulting with an experienced podiatrist at the first sign of posterior tibial tendinitis is essential since it is easy to treat when caught in its earliest stages. As the condition worsens, it can result in a permanent foot deformity and require surgery.

Causes of Posterior Tibial Tendinitis

Posterior tibial tendinitis can occur for various reasons and is a leading cause of inner foot pain. Some common causes of this condition include:

  • Overuse. Repetitive activities that put excessive stress on the posterior tibial tendon, such as running, jumping, or participating in high-impact sports, can lead to inflammation and tendinitis.
  • Age-related degeneration. The tendon may weaken and degenerate over time, especially in individuals over 40 years old.
  • Injury or trauma. An acute injury or trauma, such as an ankle sprain, can damage the posterior tibial tendon and contribute to its inflammation.
  • Foot deformities. Certain foot conditions, like flat feet or high arches, can alter the foot's mechanics and increase the strain on the posterior tibial tendon, leading to tendinitis.
  • Medical condition. Having an inflammatory medical condition such as rheumatoid arthritis can increase the risk of developing this condition.
  • Weight. Carrying a lot of body weight can strain the posterior tibial tendon and increase the risk of injury.

Common Symptoms and Stages

Those with posterior tibial tendinitis often experience pain and swelling along the inner side of their ankle and foot. In addition, common symptoms may include the following:

  • Difficulty or pain when walking, especially during activities that involve pushing off the affected foot
  • Tenderness when touching the affected area
  • Aching or throbbing sensation on the inner ankle or arch of the foot
  • Progressive flattening of the arch and inward rolling of the ankle, known as overpronation

The progression of posterior tibial tendinitis is often classified into four stages that describe the severity of the condition and its impact on the foot's structure and function. The stages are:

  • Stage 1. In this early stage, inflammation and irritation of the posterior tibial tendon occur. You may experience mild pain, swelling, and discomfort on the inside of the ankle and foot. The foot's arch remains normal, and there are no visible deformities.
  • Stage 2. As the condition progresses, the tendon continues to weaken, leading to flattening of the foot, known as adult-acquired flatfoot. Symptoms become more pronounced, and you may experience increased pain, swelling, and difficulty walking or standing on tiptoes. 
  • Stage 3. At this stage, the deformity of the foot becomes more severe. The arch collapses further and is eventually completely lost. You may experience significant pain, swelling, and difficulty walking or performing daily activities. The condition may also affect the knee and hip alignment due to altered foot mechanics.
  • Stage 4. The final stage is characterized by a permanent rigid and fixed deformity of the foot. The posterior tibial tendon is severely damaged and may not function properly. The arch remains collapsed, walking and bearing weight on the affected foot become extremely challenging, and you often experience chronic pain.

Treatment Options for Posterior Tibial Tendinitis

An experienced podiatrist can accurately diagnose posterior tibial tendinitis through a physical exam and review of your medical history. They may recommend imaging tests, such as an X-ray or MRI, to assess the extent of tendon damage. Once a diagnosis is confirmed, they will develop an individualized treatment plan based on the severity of your symptoms.

Conservative treatment may include:

  • Rest and activity modification. Avoiding activities that exacerbate symptoms and giving the tendon time to heal
  • Immobilization. Wearing a brace, walking boots, or crutches to limit movement and reduce stress on the tendon
  • Ice. Applying ice packs to the affected area can help reduce pain and inflammation
  • Medication. Medications such as ibuprofen or naproxen can help alleviate pain and reduce inflammation
  • Physical therapy. Specific exercises and stretches can strengthen the muscles and tendons around the ankle, improve stability, and promote healing
  • Custom orthotics. Custom orthotics can be worn inside your shoes to provide support, improve foot alignment, and relieve strain on the posterior tibial tendon.
  • Corticosteroid injections. In some cases, a podiatrist may administer corticosteroid injections to reduce inflammation and pain
  • Laser therapy. MLS Laser Therapy can help relieve pain and accelerate healing of the soft tissue

If conservative treatments fail to provide relief, surgical options may be considered, ranging from tendon repair to reconstruction and correction procedures.