26/02/2026
I've had this condition, very painful. Call if your experiencing any kind of pain I maybe able to diagnose and treat it refer.
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Tibialis posterior tendonitis is a key medial foot and ankle condition that directly affects arch stability and walking mechanics. The tibialis posterior muscle originates deep in the posterior leg and its tendon passes behind the medial malleolus before inserting mainly on the navicular and midfoot bones. Its primary biomechanical role is to support the medial longitudinal arch and control pronation during gait. When this tendon becomes overloaded, inflamed, or degenerative, the entire foot mechanics chain begins to change.
From a pathomechanical perspective, the tibialis posterior works eccentrically right after heel strike to control pronation and internal rotation of the foot. It slows down arch collapse and stabilizes the midfoot so the forefoot can become a rigid lever for push-off. If repetitive overload occurs — due to excessive pronation, obesity, poor footwear, sudden activity increase, or prolonged standing — the tendon experiences repeated tensile and friction stress. Over time, this leads to micro-tearing, inflammation, and tendon degeneration.
As the tendon weakens, its ability to resist pronation reduces. This creates a vicious cycle: more pronation leads to more tendon strain, which leads to further weakening. The medial arch begins to drop, the heel drifts into valgus, and forefoot abduction may appear. Instead of being a controlled shock absorber, the foot becomes a mechanically inefficient and unstable platform.
Joint coupling also changes in this condition. Excessive subtalar pronation keeps the midtarsal joints unlocked for too long during stance phase. That prevents effective resupination and reduces push-off efficiency. Patients often report medial ankle pain, fatigue while walking, and progressive flattening of the foot. In later stages, even passive correction of the arch becomes difficult due to structural adaptation.
Management from a biomechanical viewpoint focuses on reducing tendon load and restoring alignment. This includes medial arch support, rearfoot control orthoses, activity modification, calf and intrinsic foot strengthening, and progressive tendon loading programs. Addressing the pathomechanics early is crucial — because once structural collapse progresses, treatment becomes more complex and may even require surgical reconstruction.
