Understanding Posterior Tibial Tendonitis

By Neda Arjomandi, DPM — Board‑Certified Podiatrist

Posterior tibial tendonitis—often shortened to posterior tendonitis—is an over‑use or degenerative irritation of the posterior tibial tendon, the structure that lifts and stabilizes your foot’s arch every time you walk. When this tendon weakens or becomes inflamed, pain develops along the inside of the ankle and arch, and the foot may gradually flatten—eventually leading to adult‑acquired flatfoot if left untreated.

Why the Posterior Tibial Tendon Matters

• Primary arch supporter: Acts like a tension cable, preventing the arch from collapsing.

• Shock absorber: Helps distribute forces evenly when your heel strikes the ground.

• Power source: Assists in pushing off while running or climbing stairs.

When the tendon fails, everyday activities such as standing, shopping, or hiking the hills of Orange County become painful and exhausting.

Common Symptoms

If you can’t comfortably perform 10 single‑leg heel raises on the affected side, it’s a strong indicator the tendon is compromised.

Typical Causes & Risk Factors

• Repetitive high‑impact sports (basketball, tennis, pickleball)

• Sudden increase in running mileage or hill workouts

• Previous ankle injuries that never fully healed

• Flatfoot or severe pronation at baseline

• Obesity, diabetes, rheumatoid arthritis

• Unsupportive footwear or worn‑out sneakers

How We Diagnose at Laguna Woods Podiatry Group

1. Hands‑on clinical exam to localize pain and check strength.

2. Weight‑bearing X‑ray (ordered when needed) to measure arch collapse or joint arthritis.

3. Musculoskeletal ultrasound in‑office to visualize tendon fibers in real time.

4. MRI (if required) for surgical planning or to confirm partial tears.

Early, accurate diagnosis prevents long‑term joint damage and the need for complex reconstruction later.

Comprehensive Treatment Options

Conservative (≈90 % of cases)

• Immobilization: CAM walking boot or short‑leg cast 4–6 weeks to quiet inflammation.

• Custom orthotics & ankle‑foot orthoses (AFO): Redistribute pressure and protect the tendon.

• Physical therapy: Targeted eccentric strengthening, balance drills, and calf flexibility.

• Anti‑inflammatory modalities: Oral NSAIDs, ultrasound therapy, or low‑level laser.

• Regenerative injections: Platelet‑Rich Plasma (PRP) or amniotic membrane to jump‑start healing.

Surgical (when pain persists > 6 months or arch collapse is severe)

• Tendon debridement & repair for partial tears.

• Flexor digitorum longus transfer to reinforce a severely damaged tendon.

• Calcaneal osteotomy or fusion to realign and stabilize advanced flatfoot.

At Laguna Woods Podiatry Group we utilize minimally invasive techniques whenever possible, resulting in faster recovery and lower infection risk.

At‑Home Care Tips

1. Switch shoes: Wear stiff‑soled motion‑control sneakers or hiking boots.

2. Ice massage: 10 minutes on, 20 minutes off, three times daily for acute flare‑ups.

3. Night splint stretching: Keeps the calf relaxed and reduces morning pain.

4. Gradual return to activity: Follow our customized “Return‑to‑Run” or “Back‑to‑Pickleball” protocols to avoid reinjury.

Prevention Strategies

• Replace running shoes every 300–400 miles.

• Add cross‑training (cycling, swimming) to reduce repetitive stress.

• Warm‑up with dynamic calf stretches before workouts.

• Maintain a healthy BMI to reduce tendon load.

Why Choose Neda Arjomandi, DPM?

• Board‑certified foot & ankle expertise with 15+ years treating tendon disorders.

• Musculoskeletal ultrasound on‑site for same‑day visualization of soft tissues.

• Evidence‑based, patient‑centered care: From lifestyle‑friendly bracing to cutting‑edge regenerative medicine, we tailor treatment to your goals.

• Welcoming, multilingual staff fluent in English, Persian, French, and Turkish.

Ready to Walk Pain‑Free Again?

Posterior tibial tendonitis is highly treatable—especially when addressed early. Book your appointment today by calling (949) 581‑2520. We’re here to help you get back on your feet.

We proudly serve patients in Laguna Hills and neighboring communities including Laguna Woods, Mission Viejo, Lake Forest, Aliso Viejo, Laguna Niguel, Irvine, Foothill Ranch, Ladera Ranch, Rancho Santa Margarita, Dana Point, San Juan Capistrano, and San Clemente.