What is Post Tib Tendonitis?

The posterior tibial tendon originates inside of the lower leg and runs down the area just behind the medial ankle bone and attaches in the middle of the medial arch. The main attachment point is at the base of the navicular bone, where the tendon fans out to attach to other bones in the bottom of the midfoot. The posterior tibial tendon is one of the main structures which maintains and supports the arch. When the posterior tibial tendon is not functioning properly, the arch is not maintained and will eventually collapse. This is a sign of loss of muscle tone, muscle function, ligament laxity and joint instability causing the posterior tibial tendon to become overworked. The result is microtears, inflammation and the development of tendonitis. The two most common locations of pain are at the insertion of the tendon on the navicular bone and inside just behind the ankle.

Posterior tibial tendonitis is generally associated with flatfeet. But the cause is not simply an arch collapse. The development of posterior tibial tendonitis and the associated flatfoot (adult acquired flatfoot) is due to abnormal foot biomechanics. Most individuals with posterior tibial tendonitis have an abnormal amount of pronation. The foot is flexing up at the ankle, the forefoot is turning out away from the midline of the body and the heel is rotating out, away from the midline of the body leading to over pronation. The tendon eventually weakens, resulting in referred knee/hip pain added to the original foot pain as the arch continues to collapse.

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