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What is tibialis posterior tendonitis?

Tibial tendon dysfunction, also known as posterior tibial tendon dysfunction (PTTD), is a condition that causes inflammation and tearing in the posterior tibial tendon, the tendon that connects the calf muscles to the bones of the inner foot. When the condition develops, it becomes impossible for the tendon to properly support the arch of the foot and can result in adult flatfoot.

Some common symptoms of the condition include pain and swelling in the foot and ankle, as well as flattening of the foot and turning the feet and toes outwards. If left untreated, the condition can lead to arthritis in the foot and ankle at a later stage.

How can it be treated?

If you have experienced the symptoms of tibialis posterior tendonitis, Dr Narramore will perform a thorough examination of your foot to check for swelling on or near the posterior tibial tendon. He will assess your range of motion and check if there are any abnormalities with the shape of your foot. If it is necessary, Dr Narramore will perform some imaging tests, such as x-rays, ultrasound or MRI, which are helpful in ruling out other underlying conditions, such as arthritis.

While custom-made orthotics are often very effective in treating the condition initially, it may be necessary to undergo surgery. There are a number of different surgical methods that may be recommended, depending on your specific symptoms and the extent of your pain and discomfort. If Dr Narramore decides that surgery is the best option for you, he may remove the damaged tissue of the tendon and replace it with a tendon taken from another area of your foot. In many cases, he may perform an osteotomy, a procedure in which bones are cut and moved to correct flatfoot.

Post-operative care (1-2 days in hospital)

Pain control is done by popliteal nerve block (lasts +/- 12 hours) or popliteal catheter (2-3 days) making the immediate post-operative period relatively pain free. X-rays are conducted before discharge.

Non-weight bearing (NWB) on crutches which the physiotherapist will supervise. The NWB period is 6 weeks. Then, your foot will be placed into a boot and custom made medial arch support. Partial weight bearing for next 4-6 weeks.

You will need guidance by a physiotherapist for rehab in this second 6 week period.


Dr Chris Narramore consults and operates from the following locations: Constantiaberg Mediclinic or Sport Science Institute. Please contact his office directly to make an appointment and specify where you would like to be seen.


Room 207
Mediclinic Constantiaberg
Burnham Road
Cape Town 7800

Tel: +27 21 762 5228


Orthopaedic Sports Clinic
Sports Science Institute
Boundary Road
Cape Town 7700

Tel: +27 21 762 5228