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What Causes Posterior Tibial Tendonitis?

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Are you experiencing pain and discomfort on the inside of your foot or ankle? You may be suffering from posterior tibial tendonitis. This condition occurs when the tendon that connects your calf muscles to the bones on the inside of your foot becomes inflamed or injured. Posterior tibial tendonitis can have various causes. Overuse, such as repetitive activities like running or walking for long periods, is a common culprit. Poor foot arch support, wearing improper footwear, or sudden increases in activity levels can also contribute to the development of this condition. Additionally, factors like age, obesity, and certain medical conditions, such as rheumatoid arthritis or diabetes, can increase the risk of developing posterior tibial tendonitis. Understanding the causes of posterior tibial tendonitis is crucial for effective treatment and prevention. In this article, we will dive deeper into the factors that lead to this condition, explore potential risk factors, and discuss some strategies for managing and relieving the associated pain and discomfort. So, let's get started and find out more about what causes posterior tibial tendonitis!

Anatomy And Function Of The Posterior Tibial Tendon

The posterior tibial tendon, often overshadowed by flashier muscles, plays a critical role in keeping your foot stable and mobile. Nestled deep within the lower leg's posterior compartment, this long, powerful tendon originates from the tibia and fibula bones. It then travels down the back of your ankle, transforming into a broad band that fans out and attaches to several bones on the sole of your foot.

This unique structure empowers the posterior tibial tendon with a multi-faceted function. It acts as a plantar flexor , aiding in pointing your toes downwards during activities like pushing off the ground while running. More importantly, it functions as an inverter , pulling your foot inwards and stabilizing the medial longitudinal arch – the inner curve of your foot. This arch acts like a spring, absorbing shock and propelling you forward efficiently during running and walking. By maintaining proper arch integrity, the posterior tibial tendon safeguards your ankle from excessive inward rolling and potential injury.

Common Causes Of Posterior Tibial Tendonitis

The ever-reliable posterior tibial tendon, while robust, isn't invincible. When overworked or stressed, it can become inflamed, leading to a condition known as posterior tibial tendonitis. This condition can significantly impact your running and daily activities. Let's explore some common culprits that can trigger this pain:

  • Repetitive Strain: Runners, especially those who suddenly increase their mileage or intensity, are prime candidates for posterior tibial tendonitis. The repetitive stress of pushing off the ground with each stride can overload the tendon, leading to micro-tears and inflammation.

  • Improper Footwear: Shoes lacking proper arch support or with excessive wear can contribute to tendonitis. Worn-out shoes lose their shock absorption capabilities, placing extra stress on the tendon with each impact. Un supportive shoes can also allow excessive inward rolling of the foot, further straining the tendon.

  • Biomechanical Abnormalities: Flat feet or a history of ankle sprains can alter your foot's biomechanics, placing undue stress on the posterior tibial tendon. Tight calf muscles can also contribute by limiting ankle mobility and putting strain on the tendon as it compensates.

  • Age-Related Degeneration: As we age, our tendons naturally lose some of their elasticity and strength. This makes them more susceptible to overuse injuries like posterior tibial tendonitis.

Understanding these common causes is the first step towards preventing and managing this condition. By incorporating proper training practices, choosing supportive footwear, addressing biomechanical imbalances, and listening to your body, you can keep your posterior tibial tendon healthy and happy, allowing it to continue playing its vital role in your running adventures.

Common Causes Of Posterior Tibial Tendonits

Risk Factors For Developing Posterior Tibial Tendonitis

While repetitive strain and improper footwear are well-known culprits behind posterior tibial tendonitis, other factors can increase your susceptibility to this condition. Here are some lesser-known risk factors to be aware of:

  • Obesity: Carrying excess weight places significant stress on your entire musculoskeletal system, including the posterior tibial tendon. The increased demand for stability and shock absorption can lead to micro-tears and inflammation in the tendon.

  • Underlying Medical Conditions: Certain medical conditions, like rheumatoid arthritis or diabetes, can weaken the body's tissues, including tendons. This makes them more vulnerable to injury and inflammation, including posterior tibial tendonitis.

  • Sudden Increase in Activity Level: This isn't limited to just running. Weekend warriors who engage in strenuous activities like hiking or sports after long periods of inactivity are at higher risk. The sudden strain on the tendon can trigger inflammation.

  • Previous Injuries: A history of ankle sprains or fractures can alter your foot and ankle biomechanics, leading to long-term imbalances and weakness. This can put extra stress on the posterior tibial tendon as it tries to compensate for these changes.

Signs & Symptoms Of Posterior Tibial Tendonitis

Ignoring pain is a recipe for trouble, especially when it comes to posterior tibial tendonitis. Recognizing the early signs and symptoms of this condition is crucial for seeking timely treatment and preventing further damage. Here's what to watch out for:

  • Pain and Tenderness: The most common symptom is pain and tenderness along the inner ankle and the arch of your foot. This pain typically worsens with activity, especially weight-bearing exercises like running, walking uphill, or standing for extended periods. You might also experience a dull ache at rest.

  • Functional Impairment: As the condition progresses, the pain can intensify, making everyday activities like walking or climbing stairs difficult. In severe cases, a flattening of the arch (pes planus) can develop, leading to significant instability and even a visible deformity of the ankle and foot.

Treatment Options For Posterior Tibial Tendonitis

Posterior tibial tendonitis doesn't have to be a permanent roadblock. Fortunately, various treatment options can effectively address the inflammation and promote healing. Here's an overview of some common approaches:

  • Rest and Activity Modification: The first line of defense is often the simplest – rest. Reducing activities that aggravate the pain, like running or jumping, allows the tendon to heal. Replacing these with low-impact exercises like swimming or cycling can maintain fitness without further irritation.

  • Physical Therapy: A physical therapist can design a personalized program to reduce inflammation and strengthen the muscles that support the posterior tibial tendon. This program typically involves ice therapy, ultrasound treatment, and specific exercises to improve flexibility, strength, and balance in the foot and ankle.

  • Supportive Measures: custom orthotics can be incredibly effective in managing posterior tibial tendonitis. They provide arch support and help control excessive inward rolling of the foot, reducing stress on the tendon. In some cases, braces or walking boots might be used initially to immobilize the ankle and promote healing.

Bilt Labs Custom Orthotics

Posterior tibial tendonitis can be a frustrating and painful condition for runners and anyone who relies on their feet daily. While traditional treatment options like rest and physical therapy are essential, Bilt Labs custom orthotics can offer a powerful tool to manage pain and promote healing.

Here's how Bilt Labs custom orthotics can be particularly beneficial for posterior tibial tendonitis:

  • Targeted Support: Unlike generic insoles, Bilt Labs orthotics are crafted from personalized molds of your feet. This ensures a perfect fit that addresses your specific biomechanical needs. For individuals with posterior tibial tendonitis, custom orthotics can be designed to provide targeted arch support, helping to control excessive inward rolling (pronation) of the foot. This reduces stress on the inflamed tendon and promotes proper alignment.

  • Pressure Redistribution: Bilt Labs custom orthotics go beyond just arch support. They can be designed to redistribute pressure away from the inflamed area of the posterior tibial tendon. This helps to alleviate pain and discomfort during activities, allowing you to participate in physical therapy exercises or even light walking with greater ease.

  • Enhanced Stability and Balance: Custom orthotics fill any gaps between your foot and your shoe, creating a more secure fit. This enhanced stability can help prevent further strain on the tendon as you move. Additionally, improved balance can reduce the risk of falls or missteps that could aggravate the condition.

By incorporating Bilt Labs custom orthotics into your treatment plan for posterior tibial tendonitis, you can experience several benefits. They can provide targeted support, promote healing through pressure redistribution, and enhance stability, all of which contribute to a faster recovery and a smoother return to your favorite activities. Remember, consulting a healthcare professional for diagnosis and discussing the potential benefits of Bilt Labs custom orthotics with them is always recommended.

Bilt Labs Custom Orthotics


From repetitive strain to underlying health conditions, posterior tibial tendonitis has various culprits. By recognizing the risk factors and prioritizing proper footwear, training practices, and listening to your body, you can safeguard your runs and keep your feet happy. But remember, if pain persists, a healthcare professional is your best bet for a swift diagnosis and a pain-free path back to movement. Take our free quiz today to find out which orthotic type is best for your feet.

Disclaimer: The information provided in this article is intended for general informational purposes only and should not be construed as medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare professional before making any decisions about your health. If you have any questions about your health or are experiencing any medical problems, please contact your doctor or other healthcare provider immediately. Do not delay seeking medical attention based on the information provided in this article.