If you’ve been feeling a dull ache or sharp pain along the inside of your ankle or the arch of your foot — especially when walking or running, or standing for long periods — you might be dealing with something called Tibialis Posterior Tendinopathy.
This condition is a common but often misunderstood cause of medial ankle or upper arch pain. Let’s break down what it is, why it happens, and what you can do to manage and recover from it.
Where Is the Pain Coming From?
The tibialis posterior tendon runs along the inside of your ankle and attaches into the midfoot, helping to support your arch and control how your foot moves when you walk.
When this tendon becomes overloaded — often from overpronation (the foot rolling inwards too much), increased activity, or worn-out footwear — it can become irritated or painful.
Typically, pain is felt along the inside of the ankle and upper arch area (see image above).
Why Support Matters So Much
While I’m not one to rush to orthotics for every issue, with tibialis posterior tendinopathy, some level of arch support is usually essential — at least in the short term.
This tendon sits in a very vulnerable position and does a lot of heavy lifting when it comes to controlling your foot posture. When it’s irritated, we need to redistribute load so the tendon can settle and heal.
That means:
- Wearing supportive shoes (think firm heel counter and good midfoot structure)
- Considering temporary orthotic or arch support to take pressure off the tendon
- Avoiding flat, unsupportive footwear during flare-ups
Trying to manage this condition without good support often leads to ongoing pain or recurring flare-ups.
Releasing the Tight Muscle
Often, some hands-on release work through the muscle belly of the tibialis posterior can make a big difference in comfort. By releasing tension in the muscle, we can reduce the strain on the tendon itself — helping it to settle and move more freely.
This can then make your strength work far more effective. The goal is to retrain the muscle to move and activate through its natural, controlled range, rather than working it in a tight, protective, and aggravated state.
It’s a bit like psychology for muscles — once you help them relax and trust the movement again, they function more naturally.
It’s definitely worth seeing a podiatrist or physiotherapist for this part of treatment. They can perform targeted manual release techniques and then teach you simple self-release methods to maintain the benefits at home once things have loosened up.
Strengthening – The Other Half of the Equation
Strengthening is the key to long-term recovery. And it’s okay to get started on even while you are experiencing pain. The exercises should actually help the pain by the end of the set, because tendons like load and movement, they just don’t like to be cold and stiff, they need a bit of time to warm up. So the first couple of reps may be tender, but it should gradually feel better with each rep.
Tendons love progressive loading, but you need to start gently and build up gradually. Initially, isometric exercises (where the muscle contracts without movement) are a great place to start — they can help reduce pain and start rebuilding tendon capacity.
Over time, you’ll progress to more dynamic exercises that challenge the muscle-tendon unit through movement and load.
It’s really important to get guidance from a podiatrist, exercise physiologist, or physiotherapist who can tailor your program and progress it safely.
A “Drama Queen” Tendon
The tibialis posterior tendon has a bit of a reputation — it can be a “drama queen.” Even after you’ve recovered, flare-ups can happen if you suddenly increase activity, reduce your strength work, or spend lots of time in unsupportive shoes.
The good news? Once you’ve learned how to manage it, you’ll have the tools in your toolkit to calm things down quickly and get back on track.
And you can always go back to your podiatrist/EP/physio to tweak things and get things back on track – you may need some more of that hands-on release work to get back on track!
In Summary
- Pain on the inside of your ankle or arch could be linked to the tibialis posterior tendon.
- Supportive footwear and arch support are crucial early on to reduce load and allow healing.
- Progressive strengthening helps build resilience and prevent future flare-ups.
- Occasional flare-ups are normal — but important that you learn how to manage them appropriately and seek professional advice if unsure.
If this sounds like what you’re experiencing, it’s worth getting assessed by your local podiatrist or physio to confirm the diagnosis and guide your recovery plan.