Tibialis Posterior Sprain
Patient Information
A tibialis posterior sprain, or tibialis posterior tendon injury, involves damage to the tendon that runs behind the inner ankle bone (medial malleolus). This tendon plays a critical role in supporting the arch of the foot and enabling normal walking. Mr Matthew Welck is a specialist foot and ankle surgeon in London offering expert assessment and treatment for tibialis posterior tendon injuries at the RNOH Stanmore, The Wellington Hospital in North London, and Spire Bushey Hospital.
Useful patient resource: Posterior Tibial Tendon Injury – MyDr
What is a Tibialis Posterior Sprain?
The tibialis posterior muscle and tendon are responsible for inverting the foot and supporting the medial longitudinal arch. A sprain or tear of this tendon typically occurs following an eversion ankle injury (where the foot rolls outward), though it can also develop gradually due to overuse or degeneration. It is more common in middle-aged adults and those who are physically active.
Causes and Risk Factors
- Acute eversion ankle sprain or trauma causing the foot to roll outward
- Overuse or repetitive strain, common in runners and athletes
- Inflammatory conditions such as rheumatoid arthritis
- Flat foot (pes planus) which places increased strain on the tendon
- Obesity, increasing load on the tendon over time
- Age-related tendon degeneration in middle-aged and older adults
Symptoms
- Pain and swelling behind the inner ankle (medial malleolus), often worse on activity
- Tenderness along the course of the tibialis posterior tendon
- Progressive flat foot deformity — if the tendon loses function, the arch may collapse
- Difficulty rising on tiptoe on the affected leg
- Inward rolling of the ankle during walking
GP Information
Investigation Guidelines
Investigations are usually not required for initial diagnosis, management, or referral. However:
- Patients will usually have a history of an eversion injury with pain behind the medial malleolus.
- An ultrasound (USS) investigation is indicated in severe cases or where tendon rupture is suspected.
- MRI may be used to assess the extent of tendon damage and guide surgical planning.
- Advisement: ligaments and tendons may take longer to recover than fractures — patients should be counselled accordingly.
Conservative Management
Initial conservative treatment should be commenced for a minimum of 6 weeks before considering referral:
- PRICE – Protection, Rest, Ice, Compression, Elevation in the acute phase
- NSAIDs – Non-steroidal anti-inflammatory drugs to reduce pain and swelling
- Avoid activities that aggravate symptoms
- Patient education about recovery timeline and expectations
- Footwear advice – avoid completely flat shoes, high heels, or tight-fitting shoes. Supportive trainers or walking shoes with a mild heel are most appropriate.
- Over-the-counter orthotics, particularly for patients with flat feet, to support the arch and offload the tendon
Referral Indications
- Diagnostic uncertainty regarding the extent of tendon injury
- Recent or worsening flat foot deformity suggesting tendon insufficiency or rupture
- Failure of conservative measures after a minimum of 6 weeks
- Diagnostic imaging results indicating the need for specialist assessment or surgical intervention
Surgical Treatment Options
Where conservative treatment has failed or in cases of significant tendon damage, Mr Matthew Welck may recommend surgical intervention. Procedures depend on the stage and severity of the tendon injury and may include tendon repair or reconstruction, tendon transfer, and osteotomies to correct associated flat foot deformity. Early referral is encouraged to prevent progressive collapse of the medial arch.
Book a Consultation in London
For specialist assessment and treatment of tibialis posterior sprain or tendon injury in London and North London, please contact Mr Matthew Welck’s clinic to arrange an appointment at a convenient location.