Passes behind the medial malleolus to insert on the navicular and surrounding tarsals, providing the primary dynamic support of the medial longitudinal arch.
Tibialis posterior tendon dysfunction is the most common cause of adult-acquired flatfoot. Single-leg heel rise weakness and 'too many toes' sign are key clinical tests.
Medial ankle pain and early flatfoot collapse from tendon degeneration behind the medial malleolus.
Sudden flatfoot worsening with inability to perform a single-leg heel rise — typically requiring surgical reconstruction.
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