Posterior Tibialis Tendonitis

Posterior Tibialis Tendonitis

The posterior tibialis can be a real pain while hiking! It’s not a big muscle in terms of mass, but it is extremely critical for hiking on rocky terrain and having a stable foot and ankle.

The posterior tibialis is an important but often neglected muscle that supports the arch in your foot. When you walk, it helps to slow the motion of pronation (flattening of the arch) as well as assisting in supination (re-creating the arch), and maintaining the overall arch shape. Kind of a big deal.

Side inside view of bones of lower leg and foot showing Achilles tendon and posterior tibialis tendon.

The posterior tibialis lives deep behind the shin bone (tibia) and is largely obscured by other calf muscles. There is one place near the inside of your ankle that is accessible and that will be our target for massage.

What does posterior tibialis feel like?

It should be noted that any sort of self diagnosis is not advised, and this article merely acts a guide. It is not intended to diagnose or treat any issue you may be dealing with. If you suspect tendonitis, a quick trip to a medical professional is a smart and responsible action.

Common symptoms:

  1. Slow and gradual pain or discomfort on the below the inside ankle bone.
  2. Pain may be dull at first and progress to sharp.
  3. Tender to touch, maybe light swelling near the inside ankle bone
  4. In the beginning pain may decrease with a warmup but in later stages,​ it will be noticeable at rest and be worse with hiking.


The causes listed here are typically at the root of hiker foot problems. These same issues can create aches and pains further up the body including ankles, knees, hips, and low back.

  1. Overpronation
  2. Overuse
  3. Poor footwear – not the right type of shoe or your foot type, or the wrong type of footwear for the activity

Healing Time?

This will vary greatly. Hikers typically have poor nutrition which will not aid in a speedy recovery. Tendon injuries take longer to heal than muscle due to lower blood flow which is needed to bring in the nutrients and other components of healing.

What if I just pretend it isn’t there?

It’s an option, sure, but is it the best one? By ignoring the pain and just figuring it’s part of the process of long-distance hiking (it’s not) then you set yourself up for lots more hurt than you bargained for. Not to mention possibly ending your hike early due to injury.

Generally speaking, rest and maybe pain meds for acute onset. Without intervention you’ll begin to lose​ strength, ankle stability, foot motion and possibly much worse.

How do I deal with it?

Aside from rest and a doctor visit, here are some of the ways manage this issue.

Overpronation in the top image. Improved arch support in the lower image.

REST. Stop doing the thing that irritates it, which is hiking and walking.
If absolutely must continue, a heel wedge to raise your heel height with arch support typically feels much better.

Notice in the photo how this hiker overpronates in the top photo. With shoes offering better arch support she has reduced the stress and strain on multiple foot areas. Popular shoes aren’t always the best option!

Zero drop shoes may not offer you the support you need, and you should seriously consider changing it up!


Heel raise with a ball squeeze – this exercise variation will help to engage the tibialis posterior more than a traditional heel raise.


To perform:

Place a tennis ball between your heel bones

Squeeze the ball as you rise onto the balls of your feet

Slowly return to the start position

Complete 3 sets of 15 and work up to 4 sets of 20


Resisted Adduction – this will strengthen the lower leg muscles and foot muscles needed for a strong foot. Try to keep the motion just through the ankle and avoid rotating your leg to get the movement.


To perform:

Using a resistance band anchored to a stable object, place the band around your foot at the big toe joint.

In a controlled manner, pull your foot inward.

Avoid rotating the lower leg and/or hip and keep the motion just through the foot and ankle.


Arch Building Exercise – aΒ great alternative exercise to strengthen the arch muscles. You can try performing this on a slope or hill if you don’t have a wedge board. You can also use the wedge board for a great calf stretch! Instructions are in the video for this exercise.



fullsizeoutput_ba7There are two stretches that will work well here and should look familiar. The first photo shows a straight back leg which is the traditional runners stretch.

Keep your hips facing forward and parallel to the wall; they may want to rotate towards your back leg.

Keep the weight even across the bottom of your foot; for this, I think of a tripod with the big toe, pinky toe and heel.

Hold for 20 seconds, repeat 3 times. Complete 3-4 times per day.


fullsizeoutput_ba9The second photo shows a bent back knee that you will feel stretching closer to the ankle.

Keep your hips facing forward and parallel to the wall; they may want to rotate towards your back leg.

Keep the weight even across the bottom of your foot; for this, I think of a tripod with the big toe, pinky toe and heel.

Hold for 20 seconds, repeat 3 times. Complete 3-4 times per day.


DownloadΒ a free article on ways that you can improve your odds of being successful during your through hike! You’ll also receive our Track Lunge Program for FREE!

You can reach meΒ info@trailsidefitness.comΒ with any injury issues, past or present that you feel will impact your hike. Training questions are also welcome – I am happy to help!

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