“Flat Feet” and the Posterior Tibialis Muscle

by | Nov 7, 2022

Our base of support – the foot – is very important in contributing to our body’s overall biomechanics. Our feet provide propulsion, balance, and changes in direction among other functions1. They must participate in many static and dynamic movements. Today we will be speaking about the posterior tibialis muscle – a muscle associated with acquired pes planus (otherwise known as “flat feet”) – and its presentation in the body2. This is a condition that occurs in adolescence or adulthood where the natural arch of the foot begins to “fall” or “flatten”.

The posterior tibialis can be found in the lower leg deep to the calf muscles. Due to its orientation and its ultimate attachment on the underside of the foot it is a stabilizing muscle and is very important in the medial arch of the foot3. When the muscle stretches and lengthens and is not adequately supporting the arch of the foot, we call it Posterior Tibialis Tendon Dysfunction (PTTD), which is the most common cause of adult acquired flat foot.

This condition is under-diagnosed in several populations. Some of the risks factors for developing “flat feet” are being of older age, youth athletes, or having hypertension, obesity, or diabetes. PTTD can result in pain in the medial arch initially that over time becomes painful at the outer ankle that is exacerbated by activity4. There are several stages to PTTD that require their own specific management plan5. Should the condition require conservative care one may receive therapy in the form of foot orthoses, joint mobilizations, strengthening exercises, and postural re-education, among others. Should the condition be advanced, further considerations can be made with your physician. As with many conditions, the earlier it is detected means better clinical outcomes6.

Our foot health is an integral part of our body’s overall health and are very involved in the overall performance of athletes. Be sure to care for your feet, or ask how members of our team can assist you with these treatments.

-Dr. Sara Brand, DC

Houglum PA, Bertoti DB. Brunnstrom’s clinical kinesiology. FA Davis; 2012

Knapp PW, Constant D. Posterior Tibial Tendon Dysfunction. May 2019 Available from: https://www.ncbi.nlm.nih.gov/books/NBK542160/

R. Edwards, C. Jack, S.K. Singh. Tibialis posterior dysfunction. Current Orthopaedics 2008; 22: 185 – 192

Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthop Rel Res 1989;239:196-206

Bubra PS, Keighley G, Rateesh S, Carmody D. Posterior tibial tendon dysfunction: an overlooked cause of foot deformity. Journal of family medicine and primary care. 2015 Jan;4(1):26.

Kohls-Gatzoulis J, Angel JC, Singh D, Haddad F, Livingstone J, Berry G. Tibialis posterior dysfunction: a common and treatable cause of adult acquired flatfoot. BMJ.2004;329:1328-1333

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