/ CONDITIONS / POSTERIOR TIBIAL TENDINITIS
Posterior Tibial Tendinitis
Pain and swelling along the inner ankle from inflammation of the posterior tibial tendon — one of the most commonly missed ankle diagnoses. Early treatment prevents progression to tendon degeneration and arch collapse.
Andrew Gunter, DPM — San Antonio, TX.
Call (210) 581-9800
What Is Posterior Tibial Tendinitis?
The posterior tibial tendon runs from the calf muscle, behind the inner ankle bone (medial malleolus), and attaches to several bones on the inner side of the midfoot. Its primary function is to support the medial arch during walking and to control the inward rolling of the foot during the gait cycle. When this tendon becomes acutely or subacutely inflamed — posterior tibial tendinitis — it produces a characteristic pattern of pain along its course that is frequently mistaken for an ankle sprain or dismissed as general ankle pain.
Posterior tibial tendinitis differs importantly from the more advanced condition of posterior tibial tendon dysfunction (PTTD). In PTTD, the tendon has undergone progressive degeneration and partial or complete failure — leading to the adult-acquired flatfoot deformity with arch collapse and heel valgus. Posterior tibial tendinitis describes the earlier inflammatory stage, where the tendon is irritated and painful but still structurally intact and functioning. This distinction matters because tendinitis at this stage responds well to conservative treatment, while advanced PTTD requires more complex management.
The condition is frequently misdiagnosed — partly because the inner ankle location overlaps with the area affected by medial ankle sprains, and partly because many patients and clinicians are unfamiliar with this specific tendon as a pain source. A patient who sprains the medial side of the ankle, or who develops progressive inner ankle pain with no clear injury, should be evaluated for posterior tibial tendon involvement rather than managed as a generic ankle sprain.
Common contributing factors include overpronation, flat feet, a sudden increase in activity involving repetitive foot plantarflexion and inversion, and footwear without adequate arch support. Dr. Gunter evaluates the posterior tibial tendon specifically — assessing tenderness along the tendon course, single-heel-rise testing, and the foot's structural mechanics — before recommending a treatment plan targeted at both the acute tendon inflammation and the underlying mechanical contributors.
COMMON SYMPTOMS:
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Pain behind and below the inner ankle bone
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Swelling along the inner ankle and arch
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Pain that worsens with activity — walking, running, stairs
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Tenderness along the tendon course from ankle to midfoot
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Difficulty or pain with single-leg heel rise
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Pain that improves with rest but returns with activity
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Inner ankle aching that builds throughout the day
POSTERIOR TIBIAL TENDINITIS VS. ANKLE SPRAIN
Ankle sprain:
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Lateral (outer) ankle pain most common
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Follows a specific twisting injury
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Ligament tenderness on outer ankle
Posterior tibial tendinitis:
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Inner ankle and arch pain
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Often develops gradually without a single injury
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Tendon tenderness behind the inner ankle bone
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Pain with arch loading and single-heel rise
Both can result from ankle rolling injuries — inner ankle involvement after an inversion sprain should be evaluated for tendon involvement.
Treatment Options for Posterior Tibial Tendinitis
Treatment addresses both the acute tendon inflammation and the biomechanical factors driving it. Addressed early, posterior tibial tendinitis resolves well with conservative management.
Activity modification & tendon rest
Reducing the provocative loading while maintaining appropriate activity is the foundation of tendinitis management. Complete rest is rarely the right answer — but activities that repeatedly stress the posterior tibial tendon require modification during the acute inflammatory phase. Dr. Gunter advises on appropriate activity levels based on your presentation.
Custom orthotics
Controlling overpronation — the most common biomechanical driver of posterior tibial tendinitis — through precision custom orthotics reduces the chronic eccentric load on the tendon and supports the medial arch dynamically. Orthotics are the most important conservative tool for preventing recurrence once the acute inflammation is resolved.
Bracing & support
For more significant tendon involvement, an ankle brace or short-leg walking boot provides the level of tendon unloading that activity modification alone cannot achieve. Dr. Gunter determines the appropriate level of external support based on the severity of your presentation.
Tendon rehabilitation
Targeted eccentric strengthening of the posterior tibial muscle and progressive loading rehabilitation — introduced at the appropriate stage of recovery — restores tendon strength and reduces long-term recurrence risk. Rehabilitation is essential for a durable outcome.
Related conditions: Arch pain & flat feet · Posterior tibial tendon dysfunction · Ankle sprains & instability · Custom orthotics
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Frequently Asked Questions — Posterior Tibial Tendinitis
Inner ankle pain that keeps coming back?
It may not be a sprain.
Dr. Andrew Gunter, DPM evaluates posterior tibial tendinitis specifically — distinguishing it from ankle sprains and from advanced PTTD — and addresses both the acute tendon inflammation and the biomechanical factors driving it. Serving San Antonio and surrounding communities. Same-day appointments available. Most insurance plans accepted.
Call (210) 581-9800