ankle pain

You may have noticed an ache along the inside of your ankle, and perhaps your arch appears flatter than it once did. Many patients put this down to an old sprain or early arthritis, which is an understandable assumption. However, these symptoms frequently point to the tibialis posterior tendon, which plays a central role in supporting the arch of your foot.

When this tendon is repeatedly overloaded, it can become inflamed and gradually lose its capacity to hold the arch in position, a condition known as tibialis posterior tendonitis. Recognising it early makes a meaningful difference to how well it responds to treatment. Fortunately, there is a simple test you can perform at home to gauge how well the tendon is coping.

In This Article

• Tibialis posterior tendinopathy causes gradual inner ankle pain behind the medial malleolus, usually from tendon wear rather than inflammation.
• As the tendon weakens, it can no longer hold the arch up, leading to a progressive collapsing foot deformity or “fallen arch.”
• Women over 40, people with flat feet, extra weight, diabetes or high blood pressure, and prior steroid injections face higher risk.
• Struggling to complete 8–10 single-leg heel raises, or the heel not turning inward, suggests tendon dysfunction needing assessment.
• Treatment is usually non-surgical, using supportive lace-up shoes, orthoses, reduced walking load and progressive strengthening, with surgery reserved for stiff or worsening arches.

What Is Tibialis Posterior Tendonitis, and Why Does the Arch Drop?

If you’ve noticed an ache on the inside of your ankle during your daily walk, your tibialis posterior tendon may be involved.

This tendon runs behind the medial malleolus, the bony bump on your inner ankle, and acts as your arch’s main muscle-powered support.

Despite the name “tendonitis”, the problem is usually gradual wear within the tendon rather than inflammation. For this reason, clinicians often call it tibialis posterior tendinopathy.

Why Does the Arch Drop?

As the tendon weakens, it can struggle to hold your arch up. Over time, this posterior tibial tendon dysfunction may allow the arch to gradually flatten, creating what’s commonly known as a fallen arch.

Clinically, we refer to this as progressive collapsing foot deformity.

Many people mistake the early signs for an ankle sprain or arthritis, which can delay proper assessment. While your foot remains flexible, podiatrists usually begin with non-surgical care.

Why Inner Ankle Pain Is Often Missed, and Who’s Most at Risk

Why It Often Goes Unnoticed

Inner ankle pain when walking tends to develop gradually, so many patients put it down to an old sprain, arthritis or simply getting older.

Because the ache often eases with rest, it’s easy to keep walking the Main Yarra Trail and hope it settles on its own. This slow, intermittent pattern is a key reason the condition is underdiagnosed.

An English survey found that 3.3% of women over 40 had symptoms of tibialis posterior tendinosis, yet none had been diagnosed.

Who’s Most at Risk

You may be at higher risk if you:

& Are a woman over 40

& Have flat feet

& Carry extra body weight

& Have high blood pressure or diabetes

& Have had steroid injections near the tendon

Left unmanaged, ongoing tendon wear may progress to adult acquired flatfoot, where the arch gradually flattens. Early assessment allows us to identify tendon changes sooner, when treatment is generally simpler and more effective.

A Safe At-Home Heel-Raise Check, and When to Get Help Sooner

The tibialis posterior tendon does much of the work when you rise onto your toes, so a single-leg heel raise offers a useful clue about how well it’s coping. This simple check can help you decide whether a professional assessment is worthwhile.

How to Perform the Heel-Raise Check

Please perform this check slowly and safely, stopping straight away if you feel sharp pain.

• Stand beside a kitchen bench and rest your fingertips on it for balance.
• Lift one foot off the floor so you’re standing on the other leg.
• Rise slowly onto the ball of your foot, lifting your heel as high as you comfortably can.
• Lower with control, then repeat and count how many raises you can complete.
• Rest briefly, then repeat on the other foot to compare.

What a Healthy Result Looks Like

Most people with a healthy tendon can complete 8 to 10 single-leg heel raises without significant difficulty.

As the heel lifts, it should also turn slightly inward, which shows the tendon is supporting the arch as it should.

Signs That May Point to a Tendon Problem

Certain findings suggest the tendon may be under strain and is worth having assessed.

& Difficulty completing the raises, or a clear difference between your two feet

& Pain behind or below the inner ankle bone (the medial malleolus)

& The heel not turning inward as you rise

& One arch appearing flatter than the other when standing

These findings may indicate posterior tibial tendonitis or early adult-acquired flatfoot, where the arch gradually collapses.

Early assessment and treatment, such as targeted strengthening, supportive footwear or custom orthotics, generally lead to better outcomes.

When to Seek Care Sooner

Book a prompt appointment if your pain began after a fall, twist or direct knock, as this may involve a tendon tear or fracture requiring imaging.

Avoid the heel-raise check in this situation until you have been assessed.

If your foot becomes red, hot and swollen and you have diabetes or numbness in your feet, seek urgent medical care the same day, attending your nearest emergency department if needed.

These signs may indicate serious infection or Charcot foot, both of which require immediate treatment.

This information is general in nature and isn’t a substitute for an individual assessment by a qualified health professional.

How a Podiatrist Treats Tibialis Posterior Tendonitis

In many cases, your podiatrist will start by easing the load on the tendon with supportive lace-up shoes and orthoses (shoe inserts that support your arch), fine-tuning them as your foot responds.

From there, you’ll typically build the tendon’s strength step by step, so it can handle more without being overloaded.

If your symptoms don’t settle, a brace or a short spell in a moon boot may help, and occasionally your podiatrist might refer you to talk about surgery.

Supportive Shoes and Orthotics to Ease the Load

Your footwear plays a significant role in how much strain the tibialis posterior tendon absorbs with every step. Thongs and flimsy flats offer little structural support, leaving the tendon to hold up your arch on its own.

A lace-up shoe with a firm heel counter, the stiff cup around your heel, helps stabilise the foot so the tendon doesn’t have to work as hard. Many patients also benefit from orthoses, shoe inserts that support the arch and are typically fine-tuned over several visits as the foot responds.

Whether the issue is tendon wear or posterior tibialis tenosynovitis (irritation of the tendon’s sheath), reducing the load gives the tissue a chance to settle. This creates the right conditions for rebuilding strength through a structured rehabilitation program.

Strengthening the Tendon Without Overloading It

Once supportive footwear and orthoses have reduced the strain on your tibialis posterior tendon, the next step in your care is usually a structured strengthening program.

Because tibialis posterior tendonitis is most often a degenerative change in the tendon (tendinosis) rather than true inflammation, the tendon needs gradual, controlled loading to recover.

A small 12-week trial found that adding resistance exercise to orthoses improved pain and function more than orthoses combined with stretching alone.

In the clinic, we generally progress through two stages:

• Early stage: Seated resisted foot turns with a resistance band, to load the tendon gently.
• Later stage: Double-leg, then single-leg heel raises while holding a kitchen bench for balance, to build arch strength and control.

We progress your tibialis posterior strengthening exercises slowly, and sharp or lingering pain is usually a sign to ease back.

Done consistently, this approach to tibialis posterior tendonitis treatment may help support a flexible arch and lower the risk of developing progressive collapsing foot deformity.

When a Brace, a Moon Boot or Surgery Comes Into It

While supportive footwear, orthoses and a structured strengthening program often settle tibialis posterior tendonitis, some feet need additional protection for a period.

Your podiatrist will recommend the level of support based on how irritable your tendon is:

• Ankle brace: If the tendon is very painful or swollen, a brace can stabilise your inner ankle and arch as you walk.
• Moon boot: When the tendon needs more rest, a removable walking boot can briefly offload it while you stay mobile. As symptoms settle, you’ll gradually return to supportive shoes and strengthening.

Surgery is usually considered only if your arch becomes stiff or continues to flatten despite consistent non-surgical care.

While your foot remains flexible, posterior tibial tendon dysfunction (PTTD) is often managed without an operation, and if surgery is needed, your podiatrist can arrange a referral.

Can You Keep Walking With Inner Ankle Pain?

When the inside of your ankle aches, the key question is how much walking is too much. In most cases you don’t need to stop altogether, but the posterior tibial tendon often needs a lighter load while it settles.

In clinic, we generally recommend the following adjustments:

• Swap long loops on the Main Yarra or Plenty River trails for shorter, flatter walks.
• Wear supportive lace-up shoes with a firm heel counter rather than thongs.
• Ease back if pain lingers into the next morning, as this suggests the tendon has been overloaded.
• Pause hill walking for now, and treat inner ankle pain from running as a sign to switch to walking.
• Repeat the single heel raise test while holding a kitchen bench to track changes in strength and pain.

If walking continues to hurt, posterior tibial tendonitis treatment typically includes a structured, adjusted activity plan. This is general information, and an individual assessment can tailor your limits to your foot and your goals.

Frequently Asked Questions

Do I Need a GP Referral to See a Podiatrist at Bellevue Podiatry?

No, you don’t need a GP referral to see a podiatrist at Bellevue Podiatry. Podiatrists are first-contact practitioners, which means you can book an appointment with us directly.

You may book in for concerns such as inner ankle pain or a flattening arch without seeing your GP first.

During your initial consultation, we’ll assess your symptoms and discuss an appropriate, evidence-based management plan.

When a GP Referral Is Required

A referral is typically needed only if you wish to access government-funded podiatry care:

• Medicare rebates: You’ll need a referral from your GP under a Chronic Disease Management Plan to claim a rebate for eligible podiatry services.
• Department of Veterans’ Affairs (DVA): If you hold a DVA card, a valid GP referral is generally required before your appointment.

To arrange an appointment, please book online or call Bellevue Podiatry on (03) 9457 2336.

Will I Need an Ultrasound or MRI to Confirm the Diagnosis?

In most cases, imaging isn’t needed to diagnose a tibialis posterior tendon problem. A thorough hands-on assessment in the clinic usually gives us a clear picture of how the tendon is functioning.

During your consultation, your podiatrist will typically:

• Check for tenderness and swelling behind the inner ankle bone (the medial malleolus)
• Observe your walking pattern and the position of your arch
• Ask you to perform single-leg heel raises to assess tendon strength and function

An ultrasound or MRI may be recommended if your symptoms are unclear, began after a fall or twisting injury, or aren’t improving with treatment.

This is general information, and your individual assessment will always guide what’s right for you.

Can Tibialis Posterior Tendon Problems Affect Both Feet at the Same Time?

Yes, tibialis posterior tendon dysfunction can affect both feet at the same time, even if you’re only noticing symptoms on one side.

Many of the underlying risk factors, such as flat feet, higher body weight, high blood pressure and diabetes, affect the whole body, so both tendons may be under similar strain.

A simple way to check each side at home is the single-leg heel raise test:

• Stand facing a kitchen bench and rest your hands on it lightly for balance.
• Lift one foot off the floor and slowly rise onto the toes of your standing foot, then lower with control.
• Count how many you can comfortably complete, then repeat on the other side.

A healthy foot can typically manage 8 to 10 heel raises.

If either side struggles, feels painful, or your heel doesn’t turn inward as you rise, book online or call Bellevue Podiatry on (03) 9457 2336 for an individual assessment.

Are There Summer Sandals That May Suit a Sore Inner Ankle?

Yes, some sandals may suit a sore inner ankle, provided they’re built to support the foot much like a well-structured shoe.

When assessing a sandal, look for these features:

• Firm, contoured footbed with built-in arch support to reduce strain on the inner ankle
• Deep heel cup to keep the heel centred and stable
• Adjustable straps across the forefoot and around the heel to hold the foot securely

Avoid thongs and loose slides, as your toes and foot must grip to keep them on, which often places extra load on the tibialis posterior tendon.

This tendon runs along the inner ankle and is a common source of pain in this area.

If you already wear orthoses (custom or prefabricated arch inserts), your podiatrist can check whether they fit securely in your chosen sandals.

This information is general in nature, so please seek an individual assessment if your ankle pain persists or worsens.

Can Private Health Insurance Extras Help Cover Podiatry Visits and Orthoses?

Yes, in many cases your private health extras can help cover podiatry consultations and custom foot orthoses**. However, rebates, annual limits and waiting periods** vary considerably between policies and levels of cover.

Early assessment matters because some foot conditions go unrecognised. In an English survey of women over 40, about 3.3% (roughly 1 in 30) had symptoms of tibialis posterior tendon dysfunction, yet none had received a diagnosis.

This condition is often managed with orthoses.

Before your appointment, it’s worth asking your insurer:

• Whether your extras include podiatry and orthoses
• What rebate applies per consultation or per pair of orthoses
• Whether any waiting periods or annual limits apply

This is general information only and doesn’t replace an individual assessment.

Conclusion

Think of your arch as a bridge and your tibialis posterior tendon as the cable that holds it up. When that cable frays, it rarely snaps without warning. Instead, you’ll feel a quiet ache behind your inner ankle and notice the bridge sagging, step by step.

The good news is that tibialis posterior tendonitis responds well to early, targeted care. Recognising the warning signs and acting before the arch collapses gives you the best chance to restore strength, stabilise your foot and avoid long-term complications.

At Bellevue Podiatry, we help locals from Rosanna, Heidelberg, Watsonia, Ivanhoe and surrounding suburbs protect their foundation and keep moving with confidence. Our approach is evidence-based, drawing on extensive clinical research to tailor each treatment programme, from strengthening and load management to supportive footwear and orthotic therapy. That way, we can optimise your recovery and keep your arch, and your everyday life, firmly supported.