Tibialis Posterior Tendinopathy

October 7, 2025

Causes, Symptoms & Effective Treatment | Weaver Physiotherapy, Northwich

If you’ve been struggling with persistent pain or swelling around the inside of your ankle, especially when walking or running, you may be suffering from Tibialis Posterior Tendinopathy (TPT) — a common but often underdiagnosed cause of foot and ankle pain.


At Weaver Physiotherapy & Sports Injury Clinic in Northwich, Cheshire, our expert physiotherapists specialise in diagnosing and treating this condition using evidence-based rehabilitation, manual therapy, orthotics, and strengthening techniques — helping you return to pain-free movement and prevent further complications such as flat foot deformity.


🦶 What is Tibialis Posterior Tendinopathy?


The tibialis posterior is a key muscle located deep in your lower leg, running behind the inner ankle bone (medial malleolus) and attaching to the underside of the foot. Its primary roles are to:

    •    Support the arch of the foot

    •    Assist with inversion (turning the foot inward)

    •    Aid in plantarflexion (pointing the toes down) during walking and running


Tibialis Posterior Tendinopathy occurs when the tendon becomes overloaded, irritated, or degenerated, leading to inflammation, pain, and loss of function. It’s one of the leading causes of adult-acquired flatfoot deformity, especially in active individuals and middle-aged adults.


⚠️ Common Causes and Risk Factors


Like most tendon injuries, tibialis posterior tendinopathy usually results from repetitive strain or biomechanical overload rather than a single traumatic event. Common contributing factors include:


1. Overuse and Training Errors

    •    Sudden increases in training volume or intensity (e.g., long runs, hill work, plyometrics)

    •    Excessive walking or standing, particularly on hard surfaces

    •    Poor recovery between sessions


2. Biomechanical Factors

    •    Over-pronation (collapsed arches or “flat feet”)

    •    Weakness in the foot intrinsic muscles or calf

    •    Reduced ankle mobility or stiffness


3. Footwear Problems

    •    Worn-out shoes with poor arch support

    •    Unsuitable footwear for activity or running style


4. Systemic and Age-Related Changes

    •    Tendon degeneration with age (tendinosis)

    •    Inflammatory conditions such as rheumatoid arthritis

    •    Obesity, diabetes, or high cholesterol


At Weaver Physio, our clinicians often see tibialis posterior issues linked to poor foot mechanics and running gait, which can be accurately assessed through our Video Gait Analysis and Runner’s MOT service.


🔍 Symptoms of Tibialis Posterior Tendinopathy


The symptoms typically develop gradually and may worsen with activity. You might experience:

    •    Pain or tenderness along the inside of the ankle and foot, especially behind the bony bump (medial malleolus)

    •    Swelling along the tendon

    •    Pain when standing on tiptoes or turning the foot inwards

    •    A noticeable flattening of the arch or rolling in of the ankle

    •    Difficulty walking or running, especially on uneven ground

    •    In more advanced cases, visible foot deformity or “fallen arch” appearance


Early diagnosis and treatment are crucial — once the tendon becomes elongated or the arch collapses, recovery can take significantly longer.


🧠 How is Tibialis Posterior Tendinopathy Diagnosed?


At Weaver Physiotherapy & Sports Injury Clinic, diagnosis begins with a detailed clinical assessment:

    1.    Patient History – discussing pain location, onset, footwear, training habits, and medical background

    2.    Physical Examination – palpation along the tendon, checking arch height, strength testing, and observing gait

    3.    Functional Tests – single-leg heel raise, foot posture index, and load tolerance

    4.    Imaging (if required) – Ultrasound or MRI can confirm tendon thickening, tears, or degeneration


Our specialist physiotherapists use this information to identify the root cause and tailor a treatment plan specific to your condition and lifestyle.


💪 Physiotherapy Treatment for Tibialis Posterior Tendinopathy


Physiotherapy is the gold standard treatment for tibialis posterior tendinopathy. At Weaver Physio, we use a combination of hands-on therapy, exercise prescription, and advanced techniques to ensure full recovery and long-term prevention.


1. Load Management & Activity Modification


Initially, it’s important to reduce tendon stress to allow healing.

    •    Avoid aggravating activities (running, jumping, long walks on uneven surfaces).

    •    Replace high-impact exercise with low-impact options such as cycling or swimming.

    •    Use supportive footwear or orthotics to reduce load on the tendon.


Our physiotherapists will help you find the right balance between rest and controlled loading — essential for tendon recovery.


2. Pain Management & Early Rehabilitation

    •    Manual therapy & massage to reduce tension in the calf and surrounding tissues

    •    Taping or bracing to support the arch and unload the tendon

    •    Shockwave Therapy for chronic tendinopathy to stimulate healing and collagen regeneration

    •    Acupuncture may also help reduce pain and inflammation


These treatments help create the right environment for tissue repair before progressing to strengthening.


3. Progressive Strengthening Exercises


A key element in recovery is gradual tendon loading through targeted exercise.


Typical exercises include:

    •    Isometric heel raises (holding the position for tendon load without movement)

    •    Eccentric heel drops to build tendon resilience

    •    Resistance band inversion to strengthen tibialis posterior

    •    Single-leg balance and stability work


Our team will tailor your rehabilitation plan to your stage of recovery, ensuring safe progression.


4. Gait Retraining & Biomechanical Correction


Through Video Gait Analysis, our physiotherapists can identify issues such as over-pronation, hip weakness, or stride inefficiency that may be contributing to your condition.

Corrections may involve:

    •    Adjusting running technique

    •    Strengthening glutes and core

    •    Modifying cadence or foot strike pattern


This approach prevents recurrence and improves overall movement efficiency.


5. Orthotics & Footwear Advice


Custom or semi-custom orthotics can help restore proper foot alignment and offload the tibialis posterior tendon.

We often recommend:

    •    Supportive trainers with firm heel counters

    •    Arch-support inserts or motion-control shoes

    •    Avoiding minimalist or overly flexible footwear during rehabilitation


6. Shockwave Therapy at Weaver Physio


For chronic or stubborn tibialis posterior tendinopathy, Radial Shockwave Therapy (RSWT) is an excellent option.


Shockwave delivers high-energy sound waves into the affected tendon to:

    •    Stimulate blood flow

    •    Break down scar tissue

    •    Promote tendon healing

    •    Accelerate pain relief


This treatment is clinically proven and recommended by NICE (National Institute for Health and Care Excellence). Many patients notice significant improvement after just 3–5 sessions at Weaver Physio.


⏳ Expected Recovery Time


Recovery time depends on the severity and duration of the condition.

    •    Mild tendinopathy: 6–8 weeks with structured rehab

    •    Moderate tendon degeneration: 8–16 weeks

    •    Chronic or severe cases with flatfoot changes: 4–6 months


Consistency with your rehabilitation exercises and footwear support is key to long-term success.


🧩 Long-Term Management and Prevention


Once symptoms improve, your focus should shift to maintaining tendon health and preventing recurrence.


Our physiotherapists will guide you through:

    •    Ongoing strength and conditioning of the foot and calf muscles

    •    Flexibility routines for calves and Achilles

    •    Regular review of footwear and orthotics

    •    Gradual return to running or sport with progressive loading


For runners, we also recommend periodic Runner’s MOT or Gait Analysis sessions to catch early biomechanical changes before pain returns.


🏃‍♂️ Can Runners Get Tibialis Posterior Tendinopathy?


Absolutely — this is a common overuse injury in runners, especially those:

    •    Training on hard or cambered surfaces

    •    Increasing mileage too quickly

    •    Wearing unsupportive or worn shoes

    •    With weak calf or hip stabilisers


At Weaver Physio, we treat many runners suffering from inner ankle pain that turns out to be tibialis posterior tendinopathy. Addressing strength, mobility, and running form is essential to get you back running stronger and pain-free.


🧬 The Difference Between Tendinitis and Tendinopathy


You might see the terms “tendinitis” and “tendinopathy” used interchangeably — but they describe different stages of the same problem:

    •    Tendinitis – early, acute inflammation phase

    •    Tendinopathy – later degenerative phase with collagen breakdown and reduced healing


Understanding this difference helps us choose the right treatment — moving away from just rest and anti-inflammatories towards progressive strengthening and tissue remodelling.


🏥 Why Choose Weaver Physiotherapy for Tendon Pain?


With over 70 years of combined clinical experience, our Chartered Physiotherapists are specialists in diagnosing and treating complex foot and ankle conditions.


At Weaver Physiotherapy & Sports Injury Clinic in Northwich, Cheshire, we provide:

    •    Expert physiotherapy for tendon injuries

    •    Shockwave Therapy for stubborn or chronic cases

    •    Video Gait Analysis & Runner’s MOT to identify root causes

    •    Tailored rehabilitation & strength programmes

    •    Sports massage & manual therapy for pain relief and flexibility


We help patients across Northwich, Knutsford, Winsford, Middlewich, Frodsham, Tarporley, and Cheshire recover from tendon injuries and stay active for life.


📞 Book Your Appointment Today


Don’t let foot or ankle pain hold you back. Early treatment can prevent long-term tendon damage and arch collapse.


📍 Visit Weaver Physiotherapy & Sports Injury Clinic, Northwich

📞 Call 01606 227484

🌐 Book online at https://www.weaverphysio.com


Let our team help you recover, strengthen, and get back to doing what you love — pain-free.


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Knee pain is one of the most common musculoskeletal complaints we see at Weaver Physiotherapy & Sports Injury Clinic in Northwich, Cheshire. From runners and athletes to office workers and retirees, knee problems can affect anyone. While many people are familiar with conditions such as arthritis, meniscus tears, or ligament injuries, one often-overlooked cause of knee swelling and discomfort is a Baker’s Cyst. Also known as a popliteal cyst, this condition can cause swelling behind the knee, stiffness, and reduced mobility – and if untreated, it may lead to ongoing pain or limit your ability to exercise, walk comfortably, or perform daily activities. In this in-depth guide, we’ll explain what a Baker’s Cyst is, the symptoms to look out for, why it develops, and most importantly – how physiotherapy can help you manage, treat, and prevent it. What is a Baker’s Cyst? A Baker’s Cyst is a fluid-filled swelling that develops behind the knee, in the popliteal space. It occurs when excess joint fluid (synovial fluid) escapes from the knee joint and collects in a small sac behind the knee. This fluid build-up is often a result of an underlying knee problem, such as: • Osteoarthritis (wear and tear of the knee joint) • Rheumatoid arthritis • Meniscus injuries (cartilage tears) • Ligament injuries • Knee joint inflammation The cyst itself is not dangerous, but it can be painful, restrict movement, and cause the back of the knee to feel tight – especially when bending or straightening the leg. Symptoms of a Baker’s Cyst Some people with a Baker’s Cyst may not experience symptoms at all, especially if the cyst is small. However, when symptoms do occur, they may include: ✔️ A noticeable lump or swelling behind the knee ✔️ Tightness or stiffness in the back of the knee ✔️ Pain or aching, particularly when straightening or bending the leg ✔️ Reduced flexibility and mobility ✔️ Swelling in the calf (if the cyst bursts and fluid leaks down the leg) In rare cases, a ruptured Baker’s Cyst can mimic the symptoms of a blood clot (deep vein thrombosis – DVT), with sudden calf swelling, pain, and redness. If you experience these symptoms, urgent medical assessment is required. Causes: Why Do Baker’s Cysts Develop? A Baker’s Cyst does not develop in isolation – it usually results from knee joint changes or injury that causes excess fluid production. Common causes include: 1. Arthritis • Osteoarthritis is a major cause. As the cartilage wears down, the joint becomes inflamed, leading to fluid build-up. • Rheumatoid arthritis, an autoimmune condition, can also trigger joint swelling and cyst formation. 2. Sports Injuries • Damage to the meniscus (cartilage) can irritate the joint and lead to cysts. • Ligament injuries (ACL, MCL) may also increase fluid build-up. 3. Overuse or Repetitive Strain • Runners, cyclists, and people who frequently squat or kneel may place repetitive stress on the knee joint, contributing to cyst formation. 4. Underlying Inflammation • Any condition that causes inflammation within the knee joint (including gout) can lead to synovial fluid leakage and cyst development. Diagnosis of a Baker’s Cyst At Weaver Physiotherapy & Sports Injury Clinic, our Chartered Physiotherapists carry out a detailed assessment to identify whether your knee pain and swelling are caused by a Baker’s Cyst, or another condition. The process may include: 🔹 Clinical assessment – checking your symptoms, medical history, and examining the back of the knee for swelling. 🔹 Ultrasound scan – often recommended to confirm the diagnosis. 🔹 MRI scan – if an underlying injury such as a cartilage tear is suspected. Early diagnosis is key. Many patients believe they just have “knee swelling” without realising it’s linked to an underlying joint issue. How Physiotherapy Helps Baker’s Cyst Physiotherapy is one of the most effective ways to manage and treat a Baker’s Cyst. While draining the cyst or surgery is sometimes required in severe cases, the majority of patients benefit from conservative treatment that targets the root cause. At Weaver Physio, our approach focuses on: 1. Pain Relief & Swelling Reduction • Manual therapy to ease stiffness • Ice, compression, and elevation strategies • Advice on activity modification to avoid aggravation 2. Improving Knee Mobility • Gentle stretching exercises to restore range of movement • Targeted flexibility work for the hamstrings and calf muscles 3. Strengthening Exercises • Quadriceps strengthening to improve joint support • Glute activation to reduce stress on the knee • Core stability to enhance overall lower-limb mechanics 4. Correcting Biomechanics • Video Gait Analysis and biomechanical assessment (part of our Runner’s MOT service) • Identifying imbalances in walking or running that may contribute to knee overload 5. Treating the Underlying Cause • If arthritis is the cause, we’ll develop a long-term joint management plan • If it’s due to a sports injury, we’ll provide a tailored rehabilitation programme Home Management Strategies Alongside professional physiotherapy, patients can often manage symptoms at home with: ✔️ Rest & Activity Modification – avoiding deep squats or repetitive knee strain ✔️ Ice Therapy – applying ice packs to reduce swelling ✔️ Compression Supports – knee braces can help control fluid build-up ✔️ Gentle Exercises – as advised by your physiotherapist When is Surgery Needed? Surgery is rarely the first option for Baker’s Cyst. It is usually only considered if: • The cyst is very large and painful • Conservative treatments have failed • The underlying cause (such as a meniscus tear) requires surgical repair In such cases, a surgeon may drain the cyst (aspiration) or repair the damaged structures inside the knee. Can a Baker’s Cyst Burst? Yes. In some cases, the cyst can rupture, releasing fluid into the calf. This can cause sudden pain, swelling, and bruising in the lower leg. It may resemble a DVT (blood clot), so it’s important to seek urgent medical advice to rule this out. Recovery Timeline Recovery depends on the underlying cause: • Minor cases: Symptoms may improve in a few weeks with rest and physiotherapy. • Arthritis-related cases: Long-term management is required, but physiotherapy helps control pain and mobility. • Sports injuries: Recovery may take 6–12 weeks, depending on the severity of the meniscus or ligament damage. At Weaver Physio, we’ll give you a personalised recovery plan so you know exactly what to expect at each stage. Preventing Baker’s Cyst While not all cases can be prevented, you can reduce your risk by: 🔹 Maintaining strong quadriceps, hamstrings, and glutes 🔹 Avoiding repetitive high-impact activities without proper recovery 🔹 Wearing appropriate footwear for your activity 🔹 Seeking physiotherapy early if you experience knee swelling or stiffness Why Choose Weaver Physio for Knee Pain? At Weaver Physiotherapy & Sports Injury Clinic in Northwich, Cheshire, we are specialists in diagnosing and treating knee injuries and conditions such as Baker’s Cyst. Here’s why patients across Cheshire – including Northwich, Knutsford, Winsford, Middlewich, Tarporley, and Frodsham – choose us: ✔️ 70+ years of combined clinical experience ✔️ Experts in sports injuries, arthritis, and musculoskeletal pain ✔️ Access to advanced services such as Shockwave Therapy, Acupuncture & Video Gait Analysis ✔️ Tailored rehabilitation plans that get to the root cause of your pain ✔️ Trusted by runners, athletes, and the local community Our goal is simple: to help you recover faster, prevent future injuries, and get back to living pain-free. Book Your Appointment If you’re struggling with knee pain or suspect you may have a Baker’s Cyst, don’t ignore the symptoms. Early treatment can make a huge difference in your recovery and long-term knee health. 📞 Call us today on 01606 227484 🌐 Visit us at http://www.weaverphysio.com Weaver Physiotherapy & Sports Injury Clinic – Your Trusted Partner in Recovery, Performance & Pain-Free Living.
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