The tibialis posterior (posterior tibial) tendon is the most anterior and medial of the tendons passing behind the medial malleolus, lying in its own groove beneath the flexor retinaculum. The malleolus acts as a pulley, turning the tendon from the back of the leg into the sole, where it fans out to insert mainly on the navicular tuberosity with slips to every tarsal bone except the talus and to the bases of metatarsals 2-4. It is the primary dynamic stabiliser of the medial longitudinal arch and the key tendon for a single-leg heel rise.
| Muscle | |
|---|---|
| Attachment | Navicular tuberosity, with slips to the sustentaculum tali, the three cuneiforms, the cuboid and the bases of metatarsals 2-4 |
Inverts and plantarflexes the foot and dynamically supports the medial longitudinal arch
Tibialis posterior tendon dysfunction (PTTD) is the most common cause of adult-acquired flatfoot, progressing from tendinopathy (stage I) through flexible deformity (stage II) to rigid deformity (stage III) and ankle involvement (stage IV). The too-many-toes sign and failed single-heel rise test are the clinical hallmarks, and resisted inversion reproduces pain. MRI and ultrasound show tenosynovial fluid, longitudinal splitting, attenuation, or complete rupture, most often behind and just below the medial malleolus where the tendon curves and its blood supply is poorest. Stage I is managed with orthotics; stage II often requires FDL tendon transfer with medialising calcaneal osteotomy and spring ligament repair; stage III-IV requires hindfoot arthrodesis. An accessory navicular (present in roughly 10 percent of people) can take much of the insertion and cause medial midfoot pain, treated if needed with the Kidner procedure.
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.
Pain and tenderness at the navicular tuberosity reproduced by resisted inversion, sometimes linked to a symptomatic accessory navicular, managed with orthotics before surgical options.
This website uses cookies to enhance your experience. Some are essential for site functionality, while others help us analyze and improve your usage experience. Please review your options and make your choice.
If you are under 16 years old, please ensure that you have received consent from your parent or guardian for any non-essential cookies.
Your privacy is important to us. You can adjust your cookie settings at any time. For more information about how we use data, please read our privacy policy. You may change your preferences at any time by clicking on the settings button below.
Note that if you choose to disable some types of cookies, it may impact your experience of the site and the services we are able to offer.
Some required resources have been blocked, which can affect third-party services and may cause the site to not function properly.
This website uses cookies to enhance your browsing experience and ensure the site functions properly. By continuing to use this site, you acknowledge and accept our use of cookies.
