Tibialis posterior tendinopathy is irritation and weakening of the tendon that runs behind the inner ankle bone and supports the arch. It causes inner ankle and arch pain and, if it progresses, a gradually flattening foot.
The tibialis posterior muscle sits deep in the calf. Its tendon curves behind the bony bump on the inside of the ankle and attaches under the arch. It helps hold the arch up and control the foot as you walk. When the tendon is overloaded, it can become painful and less able to do its job. This is called tendinopathy. It usually builds up slowly rather than starting with a single injury.
If the tendon keeps weakening, the arch may slowly drop and the heel may tilt outwards. This is known as adult-acquired flatfoot. Many people are helped by early support, footwear changes and strengthening. Picking the problem up early matters, because a foot that has become stiff and deformed is harder to correct without surgery.
The doctor asks about your symptoms and activity, then looks at the shape of your feet standing and walking. Simple tests such as a single-leg heel raise help show how well the tendon is working.
Where it helps, an ultrasound scan in the clinic can show thickening, fluid or tearing of the tendon. It also lets the doctor compare with the other side.
Standing X-rays may be arranged by referral to check the alignment of the foot and look for arthritis. MRI is sometimes arranged if a significant tear is suspected or surgery is being considered.
The findings help show whether the foot is still flexible or has become stiff. This guides whether conservative care is suitable or a surgical opinion is needed.
Your plan depends on what the assessment finds. These are the options we most often discuss.
Reducing long walks, runs or standing for a period can let the tendon settle. Lower-impact options such as cycling or swimming may help you stay active meanwhile.
Supportive shoes and arch-supporting insoles are often used to take strain off the tendon. The doctor can advise on footwear and when a custom orthotic may be worth considering.
A progressive programme to strengthen the tibialis posterior, calf and foot muscles is a core part of treatment. Exercises are built up gradually over several months.
Learn moreTaping or an ankle brace may be used for a period to support the arch and reduce pain during a flare, alongside exercise.
Learn moreSimple pain relief or short courses of anti-inflammatory medicines may ease symptoms where suitable. They are used to support activity and rehabilitation rather than on their own.
If the flat foot keeps worsening, becomes stiff, or pain persists despite a good trial of conservative care, the clinic will refer you to an orthopaedic foot and ankle surgeon to discuss surgical options.
Recovery varies with how early the problem is found. Many people with a flexible foot notice improvement within a few months of consistent exercise, footwear changes and support, although it often takes three to six months or longer to settle fully. Flare-ups can happen if activity rises too quickly. Where the arch keeps collapsing or the foot becomes stiff, conservative care may not be enough, and a surgical opinion is usually the next step.
Not always. Some people use arch supports mainly while the tendon settles and strength builds, then rely on them less. Others with a more advanced flat foot find ongoing support helpful. Your doctor can advise based on how your foot responds.
Usually you can stay active, but you may need to cut back for a while. Pain that stays mild and settles by the next day is often acceptable. Long walks, running at East Coast Park or hours of standing may need to be reduced and then built back up gradually.
Steroid injections around this tendon are generally avoided because they may weaken it and raise the risk of rupture. Treatment usually focuses on support, footwear and strengthening instead. Your doctor will discuss the options that suit your situation.
Surgery is usually considered when the foot keeps flattening, becomes stiff, or pain continues despite several months of good conservative care. The clinic can refer you to an orthopaedic foot and ankle surgeon for an opinion. The type of operation depends on the stage and is decided by the surgeon.
No. Inflexion Clinic is a private GP clinic, so you can book directly. Book online or call the clinic on +65 6222 7864.
Our clinicians will take a proper history, examine you, and give you a clear plan on the day.