Tibialis Posterior Tenosynovitis

Tibialis Posterior Tenosynovitis A Cause Of Medial Ankle Pain

Tibialis posterior tenosynovitis is an inflammatory condition involving the sheath surrounding the tibialis posterior tendon. This tendon plays a vital role in maintaining the medial arch of the foot and stabilising the ankle during walking and running. When the sheath becomes inflamed, it can cause both pain and functional limitations. Physiotherapy management can assist in preventing long-term symptoms and/or disability. At Sydney Physio Clinic, we frequently treat patients with tib post tenosynovitis and tib post dysfunction.

What Causes Tibialis Posterior Tenosynovitis?

This condition is often the result of overload, especially in activities involving prolonged standing, walking, or running… “Poor” biomechanics, such as “excessive” foot pronation and flat feet, improper footwear for chosen activities, and sudden increases in training loads are common triggers. Placing additional load on the tendon, leading to inflammation of the surrounding sheath and the resulting symptoms. 

Difference Between Tib Post Tendonitis & Tenosynovitis

Although these terms are often used interchangeably, they refer to slightly different conditions. Tendonitis would refer to inflammation of the tendon itself, whereas tenosynovitis involves inflammation of the sheath that surrounds the tendon. Both conditions may occur together, but tenosynovitis is more focused on the irritation of the fluid-filled lining that allows the tendon to glide smoothly. The symptoms are similar, including pain, swelling, and depending on severity functional limitations.

Recognising the Symptoms

A few of the common signs of tibialis posterior tenosynovitis include:

• Medial ankle and medial arch pain that worsens with weight bearing activity
• Swelling or tenderness experienced behind the medial malleolus (inside ankle bone).
• Pain during single-leg heel raise on affected side. 

With appropriate management, tibialis posterior tenosynovitis often resolves quickly. Without treatment, however, it may progress to posterior tibial tendon dysfunction. A more chronic condition that can significantly impair function.

How Do You Treat Tibialis Posterior Tenosynovitis?

Physiotherapy offers an effective approach in treating tibialis posterior tenosynovitis. At Sydney Physio Clinic, treatment includes a combination of load management, pain management, and progressive rehabilitation:

Activity Modification and Load Management

Initially, it’s important to reduce specific activities that aggravate the condition. Relative rest is necessary, avoiding high-impact sports while maintaining gentle mobility to help calm inflammation. Supportive taping or insoles/orthotics may be used to offload the tendon during the early stages of recovery.

Manual Therapy and Modalities

Our physiotherapists may use manual therapy techniques, electrotherapy devices (laser, ultrasound, shockwave therapy) to help manage pain in inflammation in the short term. A review in the Journal of Orthopaedic & Sports Physical Therapy supports manual therapy as part of a comprehensive tendon rehabilitation approach.

Progressive Strengthening and Motor Control

Strengthening the tibialis posterior muscle and surrounding foot and lower limb stabilisers is a core component of rehabilitation. Common exercises include:

• Resisted ankle inversion exercises 
• Single-leg calf raises with focus on foot posture and form
• Short foot exercises and arch lifts for the intrinsic foot muscles that assist the tib post tendon in controlling foot posture. 
• Balance and proprioception retraining

At Sydney Physio Clinic, we also like to assess the broader kinetic chain. Including hip and core strengthening to reduce load on the lower leg as appropriate. 

Footwear & Orthotics With Tib Posterior Tenosynovitis

Supportive footwear with good shock absorption can help reduce load on the tendon and ease symptoms. In more persistent cases, insoles may be beneficial, particularly for individuals with flat feet or excessive pronation. At Sydney Physio Clinic, we work closely with our in-house podiatrists to deliver a comprehensive management plan that addresses both foot biomechanics and support.

Returning to Activity When Managing Tibialis Posterior Tenosynovitis

A gradual return to physical activity is essential. Sudden spikes in training load or intensity increase the risk of symptom recurrence, particularly in running and jumping sports. Before resuming full activity, it’s important to assess technique, footwear, and strength. Ongoing maintenance exercises and regular monitoring can help prevent setbacks. At Sydney Physio Clinic, we support patients through every stage of rehabilitation to ensure a safe return to sport or daily function.

Tibialis posterior tenosynovitis is a manageable condition when identified early and treated with a targeted physiotherapy program. Through load management, strengthening, and biomechanical correction, physiotherapy reduces pain, restores function, and helps prevent progression. Sydney Physio Clinic provides expert care for foot and ankle injuries with a collaborative, evidence-based approach to recovery.