Do you have ankle pain and swelling? Could Tibialis Posterior Tendon Dysfunction be to blame?

10th February 2020
Active Step

Tibialis posterior tendon dysfunction which is also known as Adult Acquired Flat Foot is a condition affecting the tendon which runs along the inside of the ankle and into the instep. Usually, the condition develops over time with the tendon becoming weakened and damaged which leads to a gradual flattening of the arch and arthritic changes in the hindfoot (back of the foot) and ankle.

What are the signs and symptoms?

In the early stages, there is pain, tenderness and swelling along the tendon at the inside of the ankle, extending into the instep. As the condition worsens, the arch will gradually lower. The alignment of the ankle will shift in relation to the heel bone and the forefoot will start to turn out. These bony changes will cause pain and deformity due to the onset of arthritis in the foot and ankle.

What are the risks associated with developing Tibialis Posterior Tendon Dysfunction?

  • People who already have flat feet
  • Middle-aged women and the elderly are more likely to be affected by this condition.
  • People with underlying conditions such as Inflammatory Arthritis, Hypertension and Diabetes.
  • People who are undergoing steroid therapy
  • In younger athletes, especially those with an accessory navicular bone there is a greater risk of developing symptoms.
  • Loose ligaments (Ligament laxity) from previous ankle sprains and/or flexible joints (hypermobility syndrome)
  • Obesity

How does a Podiatrist diagnose this condition?

Podiatrists are specialists in diagnosing conditions of the foot and ankle. They are able to differentiate between the various causes of symptoms in this area of the body. Initially, they will take a detailed history to gain a picture of how and when the symptoms started. They will then conduct a physical examination using various clinical tests to determine which structures are affected.

A diagnosis of Tibialis Posterior Tendon Dysfunction is made when the following characteristics are met:

  • Pain, tenderness or swelling along the tibialis posterior tendon
  • Inability or reduced ability to perform a single heel raise on the affected side

In advanced cases there are signs of:

  • Notable flattening of the arch
  • Deformity of the bones in the ankle and hindfoot.
  • Turning out of the forefoot, which is also referred to as the “too many toes sign”

How is it treated?

There are various treatment options that include surgical and non-surgical approaches which are dependent on how far the condition has progressed.

If diagnosed early before there are any signs of bony changes then wearing supportive footwear with prescription foot orthoses and engaging in physiotherapy are usually sufficient in managing this condition. The use of foot and ankle bracing such as the Richie Brace is also effective in minimising the risk of further deterioration and assisting patients in continuing their activities.

Where there are signs of deformity and arthritis in the foot and ankle then a surgical opinion is necessary. In advanced cases, patients may benefit from a tendon transfer procedure to strengthen the foot and improve overall function. Where there is significant deformity and arthritis in the foot and ankle joints, then a triple arthrodesis (fusion of the foot and ankle bones) may be the most effective procedure for resolving the patient’s pain over the long term.

At Active Step we treat a wide range of foot and lower limb conditions. For more information regarding our orthotics or to book an appointment click here, or alternatively give us a call on 01489 881 204 or send us an email on, and we’ll be happy to help.

Written by Emily Ball, HCPC Registered Podiatrist, Active Step Health