Tendon Problems
The foot and ankle have several tendons that take a beating — the Achilles at the back, the posterior tibial on the inside, the peroneals on the outside. When one fails, the foot quietly changes shape.
The foot and ankle have several tendons that take a beating — the Achilles at the back, the posterior tibial on the inside, the peroneals on the outside. When one fails, the foot quietly changes shape.
Foot & Ankle · Professor Nima Heidari
The foot and ankle have several tendons that take a beating — the Achilles at the back, the posterior tibial on the inside, the peroneals on the outside. When one fails, the foot quietly changes shape.
The most common foot tendon to tear include the posterior tibial tendon, the peroneal tendons and the Achilles tendon .
The posterior tibial tendon runs on the inside of the ankle and holds the arch up; when it stretches and fails, the foot gradually flattens and aches along the inner border. The peroneal tendons on the outside stabilise the ankle and can tear or slip out of position, causing pain and a feeling of giving way. The Achilles at the back is the body’s largest tendon and is prone to both overload and rupture.
Tendon problems usually announce themselves with pain, swelling and weakness in a predictable pattern, and often a change in the shape or function of the foot. Caught early, most respond well to bracing, orthotics, activity modification and a targeted physiotherapy programme.
Where a tendon is badly torn or has already changed the alignment of the foot, surgery to repair, reroute or reinforce it — sometimes combined with a bony correction — restores function. The right approach depends on which tendon is involved, how far it has progressed, and what you need the foot to do.
Tendons fail quietly. By the time the foot has visibly changed shape, the operation that was an option six months ago has often become a more involved one.
Professor Heidari
Clinical approach
Posterior tibial, peroneal, FHL, tibialis anterior and Achilles all fail differently. Stage of disease changes the treatment more than the name does.
Stage I–II disease typically responds to a custom orthosis or brace, calf stretching and structured strengthening. The window for non-operative care closes as the foot deforms.
Stage III–IV posterior tibial tendon dysfunction needs reconstructive surgery (tendon transfer plus osteotomy or fusion). The aim is a foot that walks well, not a foot that looks unscathed.
Treatments considered
Suffering from tibialis posterior tendon dysfunction doesn’t mean you will need surgery. The application of ice packs, rest, taking anti-inflammatory painkillers under your doctor’s direction, together with wearing a specially supportive medical boot or shoe can be enough to hold up the arch of the foot and ease your pain.
Often, he will suggest taking anti-inflammatory painkillers. The type of tendon problem you have will dictate the nature of your treatment and your consultant will direct you with this too.
Common questions
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Book a Consultation →Signed off on 30 July 2026
