Tibialis posterior is the deepest and most powerful medial arch stabiliser, with broad midfoot insertion providing the dynamic keystone of the medial arch. Its loss produces progressive flatfoot.
| Origin | Posterior interosseous membrane and adjacent posterior tibia and fibula surfaces |
|---|---|
| Insertion | Navicular tuberosity primarily, with slips to cuneiforms, cuboid, and middle metatarsal bases |
| Nerve Supply | Tibial nerve (L4, L5) |
| Blood Supply | Posterior tibial artery |
| Actions | Inverts the foot — primary inversion; Plantarflexes the ankle; Primary dynamic stabiliser of the medial longitudinal arch |
|---|
PTTD stages: I (tendinopathy), II (flexible flatfoot, too-many-toes, failed heel rise), III-IV (rigid deformity). Treatment escalates from orthotics (I) to FDL transfer plus calcaneal osteotomy (II) to triple arthrodesis (III-IV).
Palpated posterior to the medial malleolus during resisted foot inversion.
Progressive PTTD from tendinopathy to flexible then rigid flatfoot, requiring escalating surgical management.
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