The inside of your ankle or arch is sore and stiff when you get out of bed. After a few minutes of walking it loosens up and feels better. Then later in the day, the ache and stiffness return. You can’t think of an injury that started it. It just began and won’t go away.
This pattern is common with tibialis posterior tendinopathy, an irritation of the tendon that runs along the inside of your ankle and supports your arch.
Pain on the outside of your foot or ankle instead? Read about peroneal tendinopathy. Pain under your heel? Read about plantar fasciitis.
What Causes Tibialis Posterior Tendinopathy?
Understanding the cause is the key to getting better.
Tibialis posterior tendinopathy is usually a repetitive strain injury, meaning stress that builds up slowly over time rather than from one event. It often starts with small mechanical problems in the foot and ankle, such as:
- Hyperpronation: when your foot rolls inward and your arch flattens too much as you walk or run. This is one of the most common contributing factors
- A stiff ankle or tight calf
- Stiff or restricted joints in the foot
- Muscle weakness
At first you don’t notice these problems because your body compensates. But the compensation changes how your foot and ankle move. With hyperpronation, for example, the tibialis posterior has to work much harder to hold up your arch with every step. This muscle runs down the inside of your lower leg, passes behind the bump on the inner ankle, and attaches to the inside of your foot. Over time, that extra stress can build into pain and tendon damage.
Our Approach: It’s Two Problems, Not One
It’s important to realize that tibialis posterior tendinopathy isn’t one problem. It’s two.
Problem #1: The injured tendon. The tendon itself needs to heal and be rehabilitated. Our treatment combines:
- Shockwave therapy, which helps stimulate tissue healing. Research shows it can be an effective treatment for tendon problems.
- Progressive loading exercises, which are the foundation of tendon rehab. The exercises have to be challenging enough to trigger healing but not so hard that they flare the tendon up. That balance is why a customized program works better than generic exercises from YouTube or TikTok.
Problem #2: What caused it in the first place. This is the part that’s often missed, and it’s just as important. Most people, and many treatment plans, focus only on the pain. But if the mechanical problems that overloaded the tendon, including hyperpronation, are never addressed, the tendon keeps getting stressed. That’s why these conditions can be so stubborn and keep coming back, even after a period of rest or treatment.
To find the cause, we perform a thorough exam to identify the specific muscle and joint restrictions and weaknesses behind your problem, and to assess how your foot moves, including whether it’s pronating too much. We then make correcting these issues a major part of your treatment plan. This includes:
- Active Release Technique (ART): a hands-on soft tissue method that releases tight, restricted muscles in the calf and foot that are hard to reach on your own
- Joint manipulation: to restore normal movement to stiff joints in the foot and ankle, when appropriate
- Home stretches and exercises
A note on orthotics: If hyperpronation is part of your problem, an orthotic can sometimes help, and we can prescribe custom orthotics in our clinic. But an orthotic is rarely enough on its own. It supports the foot from below, but it doesn’t address the muscle weakness, muscle tightness, and joint restrictions that are driving the problem. That’s why we treat it as one possible piece of your plan, not the whole plan.
Treating both problems is what gives you the best chance of not just feeling better, but staying better.
What to Expect
Your first visit. We take a full history and perform a detailed exam. This confirms your diagnosis and uncovers what is driving the problem in your case. Only then do we build your treatment plan.
Timeline. This is not a quick fix. Tendons take time to heal, and this one can be slow. We can help it heal faster and better, but most plans run about 8-12 weeks, though this varies from person to person.
Visits. Treatments like ART and shockwave can’t be done at home, so we see you in the office, usually twice a week at first, then less often as you progress.
Home exercises. Your rehab program is prescribed in our office but done at home, typically about 30 minutes a day. Please consider this commitment before booking, since the exercises are a big part of why treatment works.
When Should You Get It Checked?
It’s worth having your foot assessed if:
- The pain has lasted more than a couple of weeks
- It improves with rest but keeps coming back
- It’s starting to affect walking, exercise, or work
- Your arch seems to be flattening, or your foot is turning outward
Tendon problems are generally easier to treat when they’re caught early, before months of compensation have built up. This one matters especially, because a tendon that keeps being overloaded can gradually let the arch collapse.
Seek urgent medical care instead if you felt a sudden pop or snap, can’t put weight on your foot, or have significant swelling, bruising, numbness, or redness and warmth with a fever.
See How We Treat It
Here’s a short video on how we assess and treat foot pain in our office.
Ready to Get Started?
If inner ankle or arch pain has been hanging around, we can help you find the cause and build a plan to fix it. Book your appointment here or call us at (905) 685-7227.