Posterior Tibial Tendonitis


The human foot is an intricate structure, designed to provide support, balance, and mobility. One of the key components ensuring the foot’s functionality is the posterior tibial tendon. However, when this tendon is compromised, it can lead to a condition known as posterior tibial tendonitis, which in turn may cause posterior tibial tendon dysfunction (PTTD). This article delves into the causes of these conditions, their implications, and the underlying anatomy involved.

Anatomy of the Posterior Tibial Tendon

The posterior tibial tendon originates from the tibialis posterior muscle, located deep within the calf. It descends along the inner ankle and attaches to various bones in the foot. Its primary roles include supporting the arch of the foot and aiding in movements such as inversion (turning the sole of the foot inwards) and plantar flexion (pointing the toes downward).

What is Posterior Tibial Tendonitis?

Posterior tibial tendonitis is an inflammatory condition affecting the posterior tibial tendon. It often presents as pain, swelling, and tenderness along the inner side of the foot and ankle. The condition can be acute, following an injury, or chronic, resulting from overuse or degeneration over time.

Causes of Posterior Tibial Tendonitis

The leading cause of posterior tibial tendonitis is excessive pronation of the foot—when the foot rolls inward too much during walking or running. This abnormal movement places undue stress on the tendon, leading to inflammation and pain. Factors contributing to excessive pronation include:

  • Poor Stability: Weakness in the muscles of the foot or leg, including the glutes, can lead to improper knee alignment and over-pronation .

  • Flexible Feet in Unsupportive Shoes: Wearing shoes that do not provide adequate support can exacerbate the problem.

  • Poor Form: Incorrect form while performing activities like running, especially downhill, can increase the risk.

  • Running or Walking on Uneven Surfaces: Prolonged activity on uneven ground can lead to excessive pronation.

  • Stiff Ankle Joint or Tight Calves: Limited flexibility in the ankle or calf muscles can contribute to the condition.

Posterior Tibial Tendon Dysfunction (PTTD)

PTTD is a progression of posterior tibial tendonitis. It is characterized by a gradual change in the tendon’s structure, leading to an inability to support the foot’s arch effectively. This results in a condition commonly referred to as adult-acquired flatfoot. PTTD is a progressive disorder that can significantly impact mobility and cause pain and weakness.

Risk Factors for PTTD

Several factors increase the likelihood of developing PTTD, including:

  • Obesity: Excess weight puts additional strain on the tendon.

  • Hypertension and Diabetes: These conditions can affect blood supply and tissue health.

  • Previous Trauma: An injury to the foot can predispose an individual to PTTD.

  • Steroid Exposure: Steroids can weaken tendons and make them more susceptible to injury.


Understanding the causes and mechanisms behind posterior tibial tendonitis and PTTD is crucial for prevention and effective treatment. Recognizing the early signs of these conditions and seeking appropriate medical advice can help mitigate their impact and preserve foot health and functionality. For those experiencing symptoms, consulting with a healthcare professional is essential for a proper diagnosis and to explore treatment options tailored to their specific needs.

This article provides a comprehensive overview of posterior tibial tendonitis and PTTD, highlighting the importance of the posterior tibial tendon in foot mechanics and the various factors that can lead to its dysfunction. By addressing the root causes and implementing preventive measures, individuals can maintain healthy foot function and avoid the complications associated with these conditions.

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Written by alexstar12

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