Painful Progressive Flatfoot (tibialis posterior tendinitis)

Painful progressive flatfoot, otherwise known as tibialis posterior tendinitis occurs when the tendon of the tibialis posterior becomes inflamed, stretched or suffers a partial or total tear.

If left untreated, this condition may lead to severe disability and chronic pain. Some people are predisposed to this condition if they have flatfeet or an abnormal attachment of the tendon to the bones in the midfoot.


The tibialis posterior muscle begins just below the back of the knee and runs along the back of the leg and the tendon then passes under the inner aspect of the ankle and attaches at the inside of the mid-foot or arch area. The tendon is responsible for helping to maintain the arch in the foot while the muscle aids in lifting the heel off the ground when one walks.


When the tibialis posterior tendon is inflamed or partially torn, pain is felt from the inside of the ankle to the arch area. With a more severe injury, a swollen, or bulbous area along the inside of the ankle may also be felt. If a sudden fall in the arch occurs, this may indicate a complete rupture of the tendon which will produce severe pain and requires immediate attention. The pain is usually worse while walking and especially while rising up on the toes. Walking up and down stairs may also be very painful.


The podiatric foot and ankle surgeon will first take a complete history and physical. Examination of the involved foot includes palpating the area for pain and swelling while looking for “too many toes” sign when the foot is viewed from the back. The podiatric foot and ankle surgeon will compare the arch of the uninvolved foot to the involved foot looking for discrepancies. Muscle and tendon strength will be evaluated by having the patient move the foot against resistance. A radiograph, or X-ray, will also be taken to evaluate any bony problems along the course of the tendon. An MRI may also be indicated to identify the extent and specific location of the damage to the tendon.


Conservative treatment for this condition includes use of nonsteroidal anti-inflammatory medications, ice, physical therapy, supportive taping and bracing, or orthotic devices. Leg and foot casting may also be utilized in severe cases. In some instances, conservative treatment will not relieve the pain and surgery may be an option. Surgery for this condition involves repairing the torn or damaged tendon to restore normal function. To prevent reinjury, orthotic devices may be recommended. In severe cases, surgery on the mid-foot bones may be necessary to treat the associated flatfoot condition.

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