Posterior Tibial Tendon

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Posterior tibial tendon dysfunction is also known as adult acquired flatfoot.

Posterior tibial tendon dysfunction is a common condition that affects the foot. It is a progressive condition. This means that it will only get worse as time goes on if the problem is not addressed and treated promptly.

What Is Adult Acquired Flatfoot?

Damage to the tendon can occur as a result of an injury or due to overuse. To understand how this could affect the arch of the foot, it helps to know the anatomy a little better. Tendons are strong, flexible tissues that connect muscles to bone. The posterior tibial tendon is attached to the bottom of the calf, connecting this muscle to the bones that are located at the inside of the foot. Not only does this tendon connect muscle to bone, it also is an important supporting structure for the foot. Any weakening of this tendon due to damage or injury can cause a collapse in the structure of the foot. When the tendon no longer supports the foot, the ligaments that hold bones together also become weakened. This most notably results in a flattening of the arch at the bottom of the foot and a turning of the ankle. In most cases, the arch will lower over time unless the condition is treated properly. This can even affect the individual’s ability to walk.

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During the first stage of this condition, after the damage or injury has occurred, pain occurs along the length of the tendon from behind the ankle along to the inside of the foot. There may also be redness and swelling in the area. As the condition gets worse, the arch will begin to flatten. If no treatment is provided, the foot will turn outward. Eventually, the ankle will also roll inward, making it difficult for the affected individual to walk or even stand up for any length of time. Pain may no longer be felt along the tendon, but it may shift to the outer portion of the foot and the outside of the ankle due to stress and strain on the affected bones and joints. Arthritis may also develop if the condition goes untreated.

Causes of Posterior Tibial Tendon Dysfunction

The most common causes of damage to the posterior tibial tendon occur from an injury or from overuse. The tendon may tear or become inflamed due to an accident, such as from a fall. Overuse most commonly occurs from engaging in sports that are considered high-impact, such as basketball. Certain exercises may also lead to overuse of the posterior tibial tendon, such as hiking or running.

Risk Factors

While anyone can experience damage or injury to the tendons in the foot, some individuals may be more at risk of developing this specific condition. Those who are over the age of 40, who are overweight, who have diabetes, or who have high blood pressure may be more at risk for developing adult acquired flatfoot. In addition, women are more likely than men to experience this condition.

Diagnosing Posterior Tibial Tendon Dysfunction

Your physician will perform a visual and physical examination of the foot to determine if you have posterior tibial tendon dysfunction. The doctor will typically check for swelling and for the location of the pain. You medical provider will check on the appearance of your foot and ankle, as well as the flexibility and range of motion of your foot and ankle. There may not be a lot of tell-tale symptoms, especially at the early stages of damage to the tendon, so your physician may order imaging tests to make a proper diagnosis. An x-ray or CT scan may be used to check for bone positioning, while an MRI or ultrasound might be necessary to check the condition of soft tissues in the area.


Treatment options may vary depending on the severity of the symptoms and the progression of the condition. If caught at the onset of symptoms, rest, ice, immobilization, and NSAIDs may be enough to reduce swelling and pain. Once inflammation is reduced, your physician may recommend shoe inserts or an orthotic device to properly support the foot and ankle during use. Physical therapy may also be necessary to restore range of movement and flexibility of the tendon.

If the condition is severe or less invasive measures do not help, surgery may be necessary. There are several types of surgery that may be used alone or in combination on the calf muscle, the posterior tibial tendon, or even the bones in the foot and ankle to allow the individual to walk better or to alleviate severe symptoms.