Few people have heard of the posterior tibial tendon until it starts to hurt. Then it becomes hard to ignore: an ache along the inside of the ankle, swelling just behind the ankle bone, and a sense that one foot is getting tired long before the other. Some people notice their arch on that side looks lower than it used to.
This is a condition worth catching early, because the tendon plays a central role in holding up the arch, and the sooner it gets support, the more options you have.
What this tendon does
The posterior tibial tendon runs from a muscle deep in your calf, down behind the bony knob on the inside of your ankle, and attaches to the bones in the middle of your arch. Each time you step, it helps lift the arch and steady the foot as you push off. Think of it as one of the main cables holding up a suspension bridge.
When the tendon is overworked, irritated or gradually stretched out, it can no longer support the arch as well. Over time, the arch can lower, the heel can tilt outward, and the forefoot can drift to the side. This progression is sometimes called adult-acquired flatfoot.
Who tends to get it
- Adults over 40, and women somewhat more often than men.
- People carrying extra body weight.
- Those with high blood pressure, diabetes, or inflammatory arthritis.
- People who already have flatter feet.
- Anyone who has had an injury to the inside of the ankle.
Signs to watch for
- Pain and swelling along the inside of the ankle and arch, worse with activity.
- One foot looking flatter than the other, or more of the toes visible from behind on that side.
- Trouble standing up on the toes of that foot alone.
- Fatigue or aching on long walks or standing.
- In later stages, pain on the outside of the ankle as the foot shifts position.
Why early care matters
In the early stages the tendon is sore and swollen but the foot still keeps its shape and can be supported well without surgery. As the condition progresses, the arch can become fixed in a flattened position, and treatment becomes more involved. A podiatrist can check the strength of the tendon, the flexibility of the foot, and how you stand and walk, and may use X-rays, ultrasound or MRI to see what is going on.
How it is treated
- A short period in a walking boot to rest the tendon during a painful flare.
- Custom orthotics that support the arch and take strain off the tendon.
- An ankle brace, from a lace-up support to a custom-molded brace, for more support when needed.
- Physical therapy to strengthen the tendon and the muscles around the foot and ankle.
- Supportive shoes with a firm heel counter and good arch support.
- Activity adjustments while the tendon settles, along with attention to weight and overall health.
When the tendon is badly damaged or the foot has become rigid, surgical repair or reconstruction may be discussed. Many people, though, can manage well with bracing, orthotics and strengthening, especially when the problem is caught early. Individual results vary.
If the pain lingers
Some people find that tendon pain along the inside of the ankle hangs on even with good support and therapy. In those cases, your Heelex podiatrist can talk with you about further non-surgical options, including low-dose radiation therapy through our affiliated radiation clinic, which is sometimes considered for persistent tendon inflammation. It is one more option to weigh together, not a replacement for support and strengthening.
If one ankle has been sore along the inside or your arch seems to be changing shape, schedule a visit with our podiatry team in Knoxville. A quick evaluation now can help protect the foot you will be walking on for years to come.