Alex has given me hope when I thought my Ironman race season wouldn’t happen due to chronic Achilles issues.
Declan, London

Injury Analysis: Tibialis Posterior Tendinopathy (Medial Ankle pain)

Injury Explanation

Tibialis Posterior is a muscle located in the lower leg, deep to the calf muscles. Its tendon wraps along the inside of the foot under the medial malleolus and inserts into medial ankle and foot bones including the navicular tuberosity. The main function of the muscle is to dynamically control the amount of foot pronation and maintain the height of the longitudinal arch of the foot – both very important for running!

Injury to the tendon, commonly referred to as a tendinopathy, is a result of overload usually from excessive running (overtraining), and increase in intensity, or a lot of jumping.

What can cause it

  • Excessive amounts of running, walking, or jumping
  • Abnormal running biomechanics such as excessive rear-foot eversion (pronation) or prolonged pronation
  • Poor or worn out footwear
  • Tight musculature in hamstrings and calves
  • Poor eccentric strength of the ankles
  • Foot structure such as a pes planus

What does it feel like?

Pain behind the inside ankle-bone and around the lower ankle. This injury may start out as an occasional dull ache on the inside of the ankle/foot after running but can progress into sharp pains, even with walking, if left untreated. It may be painful to do a heel raise, and usually worsens with repetitive stress such as running. Swelling is unusual but can occur the longer the injury is left untreated. 

How to avoid it

Maintaining mobility through the calves and ankles with stretching and foam rolling as well as strength of the ankle stabiliser muscles, ankle invertors and evertors, are important for foot control whilst running. Muscular weakness higher up the chain into the leg and hips can also contribute to overloading this important dynamic muscle of the foot.

Ensure your footwear is suitable for your type of foot and if you have insoles that they are worn as recommended.


Here are some exercises to try to help improve the mobility of your lower leg and strength of your ankles.





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