Dealing with achy ankles? Find yourself wanting to massage your arches whenever you sit down? While there are many different culprits for foot pain, you may be experiencing posterior tibial tendinitis (tendonitis). This type of tendinitis causes pain in your ankles and arches and is commonly associated with developing flat feet later in life. 

“Posterior tibial tendinitis is caused by the inflammation of your posterior tibial tendon (PTT), which runs from the backside of the lower part of your calf right into the arch of your foot,” explains Jillian Aeder, PT, DPT, a physical therapist at Hinge Health. Posterior tibial tendinitis can interfere with some daily activities, whether it’s walking, running, or standing on your toes to reach for something.

While posterior tibial tendinitis may require you to show your PTT a little more TLC, it doesn’t mean you have to stop doing the things you love. In fact, exercise therapy can be just what your aching arches and ankles need to feel supported and regain strength and flexibility.

Read on to learn more about what causes posterior tibial tendinitis, signs you might have it, and exercises to help you heal, according to Hinge Health physical therapists. 

What is Posterior Tibial Tendinitis?

Your posterior tibial tendon attaches one of your calf muscles, known as your tibialis posterior muscle, to the bones on the inside arch of your foot. (You can often see it as it runs behind the inside bump of your ankle.) It’s got a big job: It helps hold up your arch, supports your foot when you walk, helps you stand on your toes, and allows your foot and ankle to turn inward. Most of the time your PTT is up to the task and is more than capable of playing its part to help shoulder your body weight so you can move with ease.  

But, like any other tendon in your body, sometimes your posterior tibial tendon can get overworked. “If your posterior tibial tendon becomes inflamed or injured, it will have a harder time supporting your foot arch,” says Dr. Aeder. Over time, the lack of arch support can lead to flat feet.

Symptoms of Posterior Tibial Tendinitis

“A tip-off sign for me is if a patient complains that it hurts to do any sort of pushing off activity — for example, it hurts when they push off to walk or run or get out of a chair,” says Dr. Aeder. Other common posterior tibial tendinitis symptoms include:

• Pain and stiffness in your foot arch. Unlike plantar fasciitis, which occurs when a band of tissue that runs along the bottom of your foot and also supports your arch becomes inflamed and translates into pain at the heel, posterior tibial tendinitis tends to be felt more in the arch. “These feelings of discomfort also tend to run all along the inside of the ankle and may feel tender to the touch,” notes Dr. Aeder. “You may see signs of inflammation, like swelling, that prevents you from having a full range of motion.”

• Flatter feet. “Over time, people notice that their foot arch has dropped, and they have less control over the midsection of their foot,” says Dr. Aeder. “This is because their posterior tibial tendon may weaken gradually to the point that it can no longer support one’s arch.” Of course, flat feet don’t always pose a problem or cause pain.  

• Difficulty standing or walking for long periods. “Your posterior tibial tendon brings your ankle inward and your toes downward to propel you forward,” explains Dr. Aeder. “If the tendon is inflamed, you may not have the endurance to stand or walk for extended periods.”

• Pain that worsens with activity. “If your posterior tibial tendon, which essentially acts as a foot stabilizer, can’t do its job correctly, then anytime you ask your ankle and foot to perform essential activities — whether it’s walking, squatting, or climbing stairs — it can be harder and more painful,” says Dr. Aeder.

Causes of Posterior Tibial Tendinitis

Here are some of the most common reasons you may experience posterior tibial tendinitis:

• Going beyond your movement sweet spot. Sometimes you may do more than what your body’s ready for, whether that’s deciding to start running every day or jumping into a high-impact sport like basketball or soccer. With the right warm-up and strengthening exercises, your body may be able to handle the quick change of pace, but, if not, it could lead to posterior tibial tendinitis.

• Muscle tightness. “Muscle tightness in your feet and ankle can force your PTT to work in awkward positions and on overtime, which can lead to inflammation or even a tear of the tendon,” says Dr. Aeder.

• Calf muscle weakness. “If your calf muscles haven’t been strengthened, your PTT may overcompensate to help your legs and feet function,” says Dr. Aeder. Over time, this can lead to stress on the PTT.

• Osteoarthritis. If you have arthritis in your feet or ankles, it can put more stress on your PTT and cause it to slowly weaken.

No matter what causes your posterior tibial tendinitis, the effects are usually the same: If it goes untreated, it could lead to the weakening of the tendon and more pain, says Dr. Aeder. In order to make sure your PTT can hold up your arch, you want to treat the tendinitis right away. The sooner you act, the sooner you can return to activities you enjoy with less pain in your feet.

Treatment of Posterior Tibial Tendinitis

When you have posterior tibial tendinitis, the last place you probably want to be is on your feet.  But the best thing you can do is work through the discomfort and stay active. It’ll help lessen the pain you’re feeling now and prevent it from getting worse in the future. “You want to make sure that you work on strengthening and stretching exercises to support the area, as well as functional movement patterns,” says Dr. Aeder. 

Here are some of the components that should make up your posterior tibial tendinitis treatment:

• Activity modification. For the first few weeks, when discomfort is probably at its peak, focus on scaling back activities that have you on your feet. Instead of going for a run, opt for a walk if that feels better. If your feet start hurting during a walk, you may want to shorten the distance. The key is to find ways to still engage in physical activity but at a level and pace that doesn’t aggravate your posterior tibial tendinitis. 

• Ice. Dr. Aeder recommends that you make ice cups: freeze a little Dixie cup filled with water, then rip most of the cup off. “It gives the ice block more of an edge,” explains Dr. Aeder. “This allows you to target the area that bothers you the most in the tendon.” She also suggests that you apply some pressure to help relieve any knots caused by inflammation. “It will take about 15 to 20 minutes for the ice to melt, which is a good amount of time for icing,” she adds.

• Supportive shoes. If you do have posterior tibial tendinitis, you may want to skip flip flops or sandals, at least initially. There's no such thing as the “perfect” shoe that works for everyone, but Dr. Aeder recommends opting for sneakers with a solid side wall. If you need to wear something dressier for work, she recommends you stick with a closed toe flat or something with straps across it to give you full-foot support.

• Orthotics and braces. You may want to consider an orthotic, a shoe insert that helps to support and position your foot. You can start with an over-the-counter option, suggests Dr. Aeder (your physical therapist may be able to provide a recommendation). If your posterior tibial tendinitis has progressed to the point where your arch has dropped, you may require custom orthotics. Another option is a simple over the counter lace-up ankle brace to help support your ankle joints and the back of your foot.

• Physical therapy. A PT can help stretch your foot and ankle to restore flexibility, and also show you specific exercises that you can do at home. They may also teach you exercises to help improve your balance, and work with you to correct your walking pattern, or gait, to help you get back to the activities you love without pain. (You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.)

• Over-the-counter pain medicines. Nonsteroidal anti-inflammatory medication (NSAIDs) such as naproxen (Aleve), ibuprofen (Advil), and aspirin can be helpful for PTT pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

These posterior tibial tendinitis exercises are recommended by Hinge Health physical therapists to improve the tendon’s flexibility and strength in order to provide you with adequate arch support. They specifically target the muscles and tendons in your ankles and feet as well as larger muscle groups in your lower body so the tendon isn’t forced to overcompensate. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Prioritize Your Warmup

“You always want to do a lower body warm-up before any sort of repetitive task like running, jumping, or even walking, especially if you have posterior tibial tendinitis,” says Dr. Aeder. “It can be a five-minute quick routine that includes dynamic movements, like hamstring stretches, calf stretches, heel walks, and toe walks.”

How Hinge Health Can Help You 

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. 

Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Carmody, D., Bubra, P., Keighley, G., & Rateesh, S. (2015). Posterior tibial tendon dysfunction: An overlooked cause of foot deformity. Journal of Family Medicine and Primary Care, 4(1), 26. doi:10.4103/2249-4863.152245

2. Knapp, P.W., Constant, D. (May 23, 2023). Posterior Tibial Tendon Dysfunction. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK542160/ 

3. Campbell, R. F., Morriss-Roberts, C., Durrant, B., & Cahill, S. (2019). “I need somebody who knows about feet” a qualitative study investigating the lived experiences of conservative treatment for patients with posterior tibial tendon dysfunction. Journal of Foot and Ankle Research, 12(1). doi:10.1186/s13047-019-0360-z

4. Draper, T.R. November 2, 2022. Non-Achilles ankle tendinopathy. UptoDate. https://www.uptodate.com/contents/non-achilles-ankle-tendinopathy