Tibialis Posterior Tendon Dysfunction

What Is Tibialis Posterior Tendon Dysfunction?

Tibialis posterior tendon dysfunction (PTTD) is a progressive condition affecting the tendon that supports the arch of the foot. It can cause pain, weakness, and a gradual collapse of the arch. Often starting with inflammation and pain, PTTD may progress to tendon elongation or rupture if left untreated. Early recognition and physiotherapy can help slow or reverse symptoms, especially in the mild early stages.

What Is Tibialis Posterior Tendon Dysfunction?

PTTD involves the stretching, weakening or tearing of the tibialis posterior tendon. This tendon plays a critical role in stabilising the foot during walking.

• Commonly affecting adults over 40,
• particularly women,
• and may be linked to obesity,
• previous ankle injuries,
• overloading,
• or systemic conditions like inflammatory arthritis.

As the tendon weakens, the arch of the foot begins to collapse, resulting in the appearance of a flatfoot deformity developing over time.

How Do You Test for Tib Post Dysfunction?

Physiotherapists assess PTTD through a combination of clinical observations and functional testing. Common indicators include:

• Loss of the medial arch. A collapsing foot posture during standing postures
• Swelling or tenderness may be experienced along the inner ankle
• Difficulty or inability to perform a single-leg heel raise on the affected side
• Foot abduction (where the heel shifts outward when viewed from behind)

Ultrasound or MRI can help confirm the diagnosis by visualising tendon degeneration or tears. Early diagnosis and intervention is key to managing the condition conservatively.

What Happens If the Posterior Tibialis Is Weak?

Weakness in the tibialis posterior can lead to biomechanical inefficiencies throughout the lower limb. As the tendon loses function, it can no longer support the arch, resulting in losing of the medial arch. This may cause compensatory changes felt in the ankle, knee, hip, and even the lower back. Over time, untreated weakness can lead to fixed deformities, pain with walking, and an altered gait pattern. Early intervention can ideally prevent these secondary complications.

How Do You Fix Posterior Tibial Dysfunction?

Physiotherapy is often the first-line treatment for early and moderate stages of PTTD. The goal is to unload the tendon, strengthen supporting muscles where appropriate, and correct any biomechanical factors deemed to be contributing. At Sydney Physio Clinic, we take have in-house podiatrists and take an evidence-based, multidisciplinary individualized approach to managing this condition.

Activity Modification and Unloading

Reducing activities that overload the tendon, such as prolonged standing, walking or running is important in the early stages to halt the progression. Patients may benefit from temporary taping to support the arch and limit stress on the tendon. Supportive footwear and orthotics can help improve alignment and reduce symptoms during daily activity.

Strengthening and Motor Control

Once acute symptoms settle, rehabilitation focuses on targeted strengthening of the tibialis posterior and other muscles that support foot and ankle stability to improve function. All strengthening is progressed gradually with load tolerance monitored. Addressing more proximal muscle control, particularly at the hips and trunk can also improve overall lower limb biomechanics.

Manual Therapy & Tibialis Posterior Tendon Dysfunction

Manual therapy techniques may be used to address any pain and stiffness. Modalities such as ice, therapeutic ultrasound, or low-level laser therapy can also assist in symptom management early on. These are typically combined with targeted exercise, footwear and support adjustments to optimise outcomes.

Custom Orthotics, Collaboration & PTTD

In moderate to advanced PTTD, custom orthotics may be required to provide structural support. At Sydney Physio Clinic, we work closely with our in-house podiatrists to provide integrated care for foot posture correction and long-term offloading of the tibialis posterior tendon. The podiatrist use the The Zebris pressure distribution measurement treadmills to provide valuable information on gait patterns and giving quantitative data to help guide decision making. 

Surgery and Tibialis Posterior Tendon Dysfunction

In severe or late-stage cases where the tendon has ruptured or deformity has become fixed, surgical options may be considered. These can include tendon reconstruction or joint fusion. Physiotherapy often remains crucial in both the pre- and post-operative phases to ensure optimal recovery and function.

Tibialis posterior tendon dysfunction is a progressive yet ideally manageable condition. Early diagnosis and physio intervention can help prevent long-term disability. At Sydney Physio Clinic, we provide tailored rehabilitation programs aimed at restoring strength, improving foot posture, and supporting return to activity. With the right treatment, many individuals with PTTD can avoid surgery and regain modest weight bearing function.