Posterior Tibia (Tibialis) Tendon Rupture

What is a Posterior Tibia (Tibialis) Tendon Rupture?

The posterior tibial tendon supports the arch of the foot. A rupture occurs when the tendon tears fully, compromising foot stability and leading to a progressive flatfoot deformity.

• Often preceded by tendinitis or chronic degeneration
• Leads to medial ankle and arch pain

Overview of the Condition

This tendon runs from the calf muscle (tibialis posterior) down behind the medial malleolus and inserts into the foot arch. A complete rupture often results in significant foot dysfunction.

Symptoms

• Medial ankle pain and swelling
• Loss of foot arch, leading to a flatfoot shape
• Inability to stand on tiptoe with affected foot

Causes

Chronic overuse, degenerative changes, or acute injury can cause tendon rupture. Obesity, diabetes, and steroid use also increase tendon vulnerability.

Diagnosis

Physical exam shows swelling along the tendon and collapse of the medial arch. MRI or ultrasound confirms the tear’s extent.

Treatment Options

• Immobilization in a cast or brace for partial tears
• Custom orthotics or ankle-foot orthosis (AFO)
• Physical therapy
• Surgical repair or reconstruction in complete ruptures

Conservative Management

Partial or early-stage ruptures may respond to bracing, rest, and anti-inflammatory measures. Orthotics can support the arch and reduce strain on the tendon.

Rehabilitation Exercises

1. Gentle range-of-motion drills
2. Progressive strengthening of foot invertors and calf muscles
3. Balance and proprioception training

When is Surgery Needed?

Surgery is required for complete ruptures or cases unresponsive to conservative therapy. Ongoing flatfoot deformity and pain indicate reconstruction or tendon transfer is needed.

Surgical Procedures

• Primary repair if ends are approximable
• Tendon transfer (e.g., flexor digitorum longus) if the posterior tibial tendon is irreparable
• Calcaneal osteotomy to correct alignment if severe flatfoot deformity

Anatomy Overview

The tibialis posterior muscle originates in the posterior leg and inserts into multiple foot bones, supporting the arch. A rupture disconnects this support, resulting in collapse.

Affected Areas

• Medial ankle behind the malleolus
• Navicular and midfoot insertions
• Surrounding ligaments if the foot alignment changes

Frequently Asked Questions

QuestionAnswerWill my arch return after treatment?Partial restoration of the arch can be achieved with reconstructive surgery or appropriate bracing, but results vary.How long is recovery after surgery?A lengthy process (3-6 months) with immobilization and therapy to regain strength and alignment.

Prevention Strategies

• Avoid overloading the tendon with sudden intense activities
• Maintain healthy body weight
• Address early signs of posterior tibial tendon pain or dysfunction

Related Conditions

• Flatfoot deformity
• Achilles tendinitis
• Medial ankle instability

Additional Treatments

Advanced bracing or custom AFOs can manage partial ruptures or post-surgical support to control foot alignment.