What is tibialis posterior tendinopathy?

Tibialis posterior tendinopathy is an overuse injury causing pain and inflammation along the inner ankle and arch, often due to repetitive stress.

What are the symptoms of tibialis posterior tendinopathy?

Common symptoms include inner ankle pain, swelling, tenderness, and difficulty with arch support and stability.

What causes tibialis posterior tendinopathy?

Causes include overuse, improper foot mechanics, and repetitive strain on the inner ankle, often seen in high-impact activities.

How is tibialis posterior tendinopathy diagnosed?

Diagnosis usually involves a physical exam and may include imaging tests like an ultrasound or MRI to confirm inflammation.

What treatment options are available for tibialis posterior tendinopathy?

Treatment includes physiotherapy for pain relief, mobility exercises, and strengthening to support recovery and prevent recurrence.

Can physiotherapy help with tibialis posterior tendinopathy?

Yes, physiotherapy is effective for reducing pain, restoring stability, and strengthening the foot and ankle for those with tibialis posterior tendinopathy.

Tibialis Posterior Tendinopathy: Symptoms, Causes, Treatment & Recovery Tips

Tibialis Posterior Tendinopathy (TPT) is a common running injury treated at Urban Physiotherapy North Sydney, often presenting as pain on the inside of the ankle. It is frequently associated with running or running-related sports and typically occurs in athletes who have recently increased their training volume or intensity.

This condition arises when the tibialis posterior tendon is subjected to excessive load, often beyond its capacity to handle. Overuse or improper training techniques can strain the tendon, leading to inflammation and discomfort. Weak calf muscles are also a common contributing factor, as they fail to adequately support the tendon during high-impact activities like running.

What are the causes of Tibialis Posterior Tendinopathy

Overuse: Increasing training volume or intensity too quickly can overload the tibialis posterior tendon, leading to pain and inflammation. This is especially common after a sudden spike in running mileage or speed.

Biomechanical Issues: Abnormal foot mechanics, such as overpronation (when the foot rolls inward) or flat feet, can place excessive strain on the tendon. Similarly, runners with high arches may have insufficient shock absorption, increasing the risk of injury.

Weak Calf Muscles: Inadequate strength in the calves can lead to an imbalance, causing the tibialis posterior tendon to compensate, which may result in tendinopathy.

Tightness in the Achilles or Calf: Tight calf muscles or Achilles tendons can affect running mechanics and add extra stress on the tibialis posterior tendon.

Sudden Changes in Activity: Transitioning to running on harder surfaces or increasing incline (e.g., hill running) can put additional strain on the tendon.

How is it diagnosed?

Subjective Examination: The subjective examination is the first step in assessing Tibialis Posterior Tendinopathy. During this phase, your physiotherapist will ask you about your symptoms, the type of pain you're experiencing, and the exact area of discomfort. Discussing how the pain started, when it worsens, and any activities that trigger it (like running) is crucial for an accurate diagnosis and treatment plan.

Physical Examination: Next, the physiotherapist will conduct a physical exam to assess the affected area. This typically involves specific muscle tests to evaluate strength and flexibility, as well as palpation (touching) to pinpoint areas of pain or tenderness. The goal is to assess your tendon function, identify any weaknesses or imbalances, and determine how well your ankle and foot are moving.

How we treat Tibialis Posterior Tendinopathy

Subjective history: The most important diagnostic criteria is through discussing your symptoms, background, previous injury history and training with a Physiotherapist.

Physical examination: A Physiotherapist will complete physical tests to rule out other structures as the only way we can 100% diagnose a bone stress injury is through an MRI.

Movement tests: In some cases movement tests e.g. hopping will be implemented, however, given this injury is quite high risk, they are usually avoided.

Treatment Options at Urban Physiotherapy

Manual Strengthening Techniques: Our physiotherapists utilize manual therapy to facilitate tendon strengthening by applying specific mobilization techniques. These techniques improve the function of the tibialis posterior tendon, ensuring proper alignment and helping it regain strength gradually.

Soft Tissue Therapy & Massage: Tightness in the surrounding muscles, particularly the calves and Achilles tendon, can exacerbate stress on the tibialis posterior tendon. Soft tissue massage and targeted manual therapy are key treatments to release muscle tension and reduce the load on the tendon. This hands-on approach improves flexibility and supports tendon healing.

Joint Mobilizations and Manipulations: We use gentle joint mobilizations to improve ankle and foot mobility. These techniques can reduce stiffness and increase the range of motion, which is essential for proper tendon function and pain relief. Joint manipulation may also be used in specific cases to restore optimal movement patterns.

Taping and Offloading Techniques: Kinesiology taping is commonly used to offload the injured tibialis posterior tendon, helping to reduce strain and provide support during recovery. This manual therapy approach helps protect the tendon while promoting healing and pain reduction.

Footwear and Posture Advice: In addition to hands-on techniques, we provide manual assessments of your posture and foot alignment. Our physiotherapists offer expert footwear advice to help you choose the right shoes that reduce strain on your tendons, promoting optimal function and decreasing stress during walking and running.

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