Posterior tibial tendon dysfunction

Posterior tibial tendon dysfunction occurs when the tendon that attaches the calf muscle to the bone on the inner part of your foot becomes inflamed or torn. Tendons connect muscles to bones and stretch across joints, enabling you to bend the joints. The posterior tibial tendon starts in your calf, stretches down behind the inside of your ankle and attaches to bones in the middle of your foot.

According to the American Orthopaedic Foot and Ankle Society, the posterior tibial tendon is one of the most important tendons in the leg because it helps hold up your arch and provides support as you step off on your toes when walking.

When the posterior tibial tendon becomes inflamed, overstretched or torn, you may have symptoms of inner ankle pain. Gradually, you may lose the inner arch on the bottom of your foot, resulting in a condition called "acquired flatfoot."


The symptoms for posterior tibial tendon dysfunction can include:

  • Pain – You can feel pain in different areas of the foot and ankle, depending on how severe the condition becomes. Pain is initially felt along the inside of your foot where the tendon lies. It can also be felt on the inside or outside of the ankle as a result of the arch collapse and rolling of the ankle. Pain is generally worse after activity.
  • Trouble walking – As the condition worsens and the arch collapses, it can become difficult to walk or even stand in one place.
  • Swelling – This can occur as a result of the inflammation or tear of the tendon. Swelling generally occurs from the lower leg to the inside of the ankle and foot.
  • Arch collapse – Once the tendon is damaged or irritated it ceases to provide its main function of supporting the arch of the foot. The arch begins to collapse and eventually will lead to flatfoot.
  • Rolling of the ankle – Once the arch collapses the heel bone begins to shift outwards to a new position. The foot will shift to a new position as well and will be out of normal alignment with the leg. This is referred to as "rolling of the ankle" and causes severe pain and extreme difficulty in walking.


Overuse and injury are the main causes of posterior tibial tendon dysfunction. Injury from a fall or landing on the foot wrong can tear the tendon and lead to dysfunction. High impact sports such as tennis, soccer, football or basketball can result in injury or overuse of the posterior tibial tendon. Overuse will cause the tendon to wear down over time and become inflamed. Once the tendon is irritated it is at a higher risk of further injury. Once the tendon is torn or inflamed it can no longer support the arch properly and the arch will begin to collapse.


Your doctor will gather your complete medical history and provide a thorough physical examination of your foot and ankle. The doctor will check for swelling, pain and tenderness along the inside of the foot and ankle. Flexibility and range of motion will be tested and a check for posterior tibial tendon dysfunction will be performed. After the physical examination is complete, your doctor will order one or more of the following diagnostic imaging tests:

  • X-ray – This type of test is used to collect pictures of dense structures like the bones. It can show if there is a fracture or misalignment of bone.
  • Magnetic resonance imaging (MRI) – This diagnostic imaging procedure can detect tissues such as tendons and muscles. Inflammation or a tear in the posterior tibial tendon can most likely be seen on an MRI.
  • Computerized tomography scan (CT or CAT scan) – This scan may be used to determine whether the condition is arthritis or posterior tibial tendon dysfunction. These conditions can possibly resemble each other on an X-ray or MRI.
  • Ultrasound – This procedure uses high-frequency sound waves to create pictures of bones and tissue. 


Treatments for posterior tibial tendon dysfunction depend upon the severity of the condition and range from conservative, nonsurgical treatment to surgical intervention for posterior tibial tendon or flatfoot reconstruction.

The multidisciplinary team of foot and ankle experts at NorthwellHealth Orthopaedic Institute treats posterior tibial tendon dysfunction as well as a broad range of foot and ankle conditions that can occur at any stage of life.

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