Ankle & Lower Leg

What It Is

Tendinopathy is a type of injury to the tendon. It can end up causing you pain, limited movement and swelling. Injuries often include tendonitis, which is an inflammation of the tendon, and tendinosis, which is a chronic form of tendonitis and can present as a tiny tear in the tendon without having a lot of inflammation.

The posterior tibial tendon attaches one of the calf muscles (the tibialis posterior muscle) to the bones on the inside arch of the foot, running behind the bony bump on the inside of the ankle. The main job of the tendon is supporting the arch in the foot (American Academy of Orthopaedic Surgeons, n.d.). If the tendon becomes weak, inflamed or torn, the arch of the foot can gradually flatten, and the foot rolls inward (pronates), which can make walking painful and difficult (American Academy of Orthopaedic Surgeons, n.d.; The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.). When this happens it is often called posterior tibial tendon dysfunction, or progressive collapsing foot deformity (American Academy of Orthopaedic Surgeons, n.d.).

Posterior Tibial Tendinopathy Anatomy

Three different bones compose the ankle joint: the shin bone (tibia), the smaller bone on the outside of the lower leg (fibula) and the small bone that sits above your heel bone called the talus.

The posterior tibial tendon is one of the most important tendons for supporting the foot. Tendons are the way that muscles attach to bones. This particular tendon runs behind and around the main bony bump on the inside of your ankle (the medial malleolus), which is often the site of pain. The main function of this tendon is to hold up the arch and support the foot when walking. It also helps you stand on your toes (American Academy of Orthopaedic Surgeons, n.d.).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Posterior Tibial Tendinopathy

Specific exercises to strengthen the tendon are extremely important for treating this condition (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.), and in studies, strengthening exercises together with stretching and orthotics helped reduce pain and disability (Ross et al., 2018). Stretching the calf and Achilles tendon is also an important part of treatment (American Academy of Orthopaedic Surgeons, n.d.). I can guide you through a strengthening and stretching programme, with hands-on work and taping to support your arch. See the My Approach tab for how I work.

1. Ice

Apply a cold pack to the most painful area of the tendon for 20 minutes at a time, 3 or 4 times a day, to help keep down swelling. Do not apply ice directly to the skin; wrap it in a thin towel (American Academy of Orthopaedic Surgeons, n.d.).

2. Rest and Recover

Avoid engaging in any activity that causes pain. Reduce the amount of impact through the ankle and foot. Reduce high-impact or heavily weight bearing sports and stick to low-impact activities that offload the area, such as swimming, cycling or an elliptical machine (American Academy of Orthopaedic Surgeons, n.d.).

3. Orthotics

Orthotics (shoe inserts, either ready-made or custom made) are the most common non-surgical treatment for this problem (American Academy of Orthopaedic Surgeons, n.d.; The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.). I can help you work out whether you need one and how to get it, and point you to a chiropodist or podiatrist if you need a custom orthotic.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Ankle brace: a brace can support the ankle and back of the foot and take tension off the tendon (American Academy of Orthopaedic Surgeons, n.d.; The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).
Boot or cast: a walking boot or cast may be used for a short time to rest the tendon, but wearing one for too long can weaken the tendon and the leg muscles, so it is usually only used if other treatments have not helped (American Academy of Orthopaedic Surgeons, n.d.; The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).
Surgery: may be considered by an orthopaedic surgeon if non-surgical treatment does not help (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).

How I can help (see the My Approach tab)

Strengthening for the tendon and the muscles that support your arch
Hands-on work for the calf, shin and foot, and taping
Help working out whether an orthotic or brace might help, and how to get one

Tips

If you are overweight, try to lose a few pounds to help alleviate the added pressure and strain on the tendon (American Academy of Orthopaedic Surgeons, n.d.; The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).
If you have flatter feet, the extra strain this puts on the tendon can make it more likely to become injured (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).
Whenever exercising or engaging in other physical activities, avoid overusing the tendon. Only do as much as your body will allow.
This condition can get worse over time, and early treatment can help stop it progressing (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.). If your pain keeps coming back or your foot seems to be getting flatter, let me know and I can advise you on this.

Treatment

My Approach

The posterior tibial tendon holds up the arch of your foot, so when it's sore, every step loads it. My aim is to settle the pain, take strain off the tendon, and build its strength back up gradually so your foot copes with walking and activity again. If your arch has already dropped, massage won't change the shape of your foot, but it can ease the aches and the tight, tired muscles that come with it.

I start by assessing your foot and ankle, how your arch behaves when you stand, walk and rise onto your toes, and the strength and flexibility of your calf and lower leg, and your footwear.

When It's Sore

Work through the calf, shin and foot to ease tension pulling on the tendon, keeping pressure light over the sore part behind the inner ankle bone
Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
Cutting back the activities that flare it, and keeping you active with swimming, cycling or an elliptical
Taping to support your arch in the short term, and I'll show you how to tape it yourself

As It Settles

Strengthening for the tendon, from gentle holds to slow, controlled loading, heel raises with the arch held up and single-leg work, plus the foot, calf and hips
Calf and Achilles stretching, using the heel as the lever so the arch isn't pushed down
Cross-fibre work on tight spots around the tendon once it's past the early, irritable stage
A home programme between visits and a gradual return to sport, with gym-based work if you lift

I'll also help you work out whether an orthotic or brace might help and how to get one, and point you to a chiropodist or podiatrist if you need a custom orthotic.

If your foot seems to be getting flatter, or the pain keeps coming back despite treatment, see your family doctor or nurse practitioner.

What to Expect

Typical Course

Typical course: Most people come once or twice a week at first, then weekly, with a reassessment at about 4 to 6 weeks, then less often as you manage more on your own. Tendon pain usually takes weeks to months to settle, and long-standing cases can take six months or more.

What I Focus On

Assessment

Calf & Foot Release

Tendon Strengthening

Taping

Orthotic & Footwear Advice

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Progressive collapsing foot deformity (flatfoot) / posterior tibial tendon dysfunction (OrthoInfo). Available at: https://www.orthoinfo.org/diseases--conditions/posterior-tibial-tendon-dysfunction/ (Accessed: 7 October 2026).
The Royal Orthopaedic Hospital NHS Foundation Trust (n.d.) Adult acquired flat foot / posterior tibial tendon dysfunction (PTTD). Available at: https://roh.nhs.uk/services-information/foot-and-ankle/adult-acquired-flat-foot-posterior-tibial-tendon-dysfunction (Accessed: 7 October 2026).
Ross, M.H., Smith, M.D., Mellor, R. and Vicenzino, B. (2018) 'Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines', BMJ Open Sport & Exercise Medicine, 4(1), p. e000430. doi: 10.1136/bmjsem-2018-000430

Massage therapy · Kitchener–WaterlooPosterior Tibial Tendinopathy

What It Is

Posterior Tibial Tendinopathy Anatomy

Self-Care & Treatment

How to Treat Posterior Tibial Tendinopathy

1. Ice

2. Rest and Recover

3. Orthotics

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Sore

As It Settles

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooPosterior Tibial Tendinopathy

What It Is

Posterior Tibial Tendinopathy Anatomy

Self-Care & Treatment

How to Treat Posterior Tibial Tendinopathy

1. Ice

2. Rest and Recover

3. Orthotics

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Sore

As It Settles

Typical Course

References

Related Conditions

Ankle Impingement (Anterior)

Ankle Sprains (Medial and Lateral)

Calf Strain / Calf Tear

Chronic Ankle Instability

Book a session