Pain and swelling on the inside of your ankle? Arch starting to look flatter than it used to? Those are the classic warning signs of posterior tibial tendonitis — and this is one condition where waiting is genuinely costly. Left untreated, it is the leading cause of adult-acquired flatfoot. Our board-certified foot and ankle surgeons diagnose it in one visit with on-site ultrasound at 9 Southwest Florida locations. Call (239) 430-3668 or book online now.
The posterior tibial tendon runs from deep in your calf, wraps behind the bony bump on the inside of your ankle, and fans out to anchor into multiple bones in your arch. It is the primary dynamic support of your arch: with every step it controls how much your foot flattens (pronates) and then helps re-form the arch for push-off. Because it works this hard on every single step, it is one of the most overloaded tendons in the body — and it affects every foot type, not just people with flat feet.
Early on, you feel aching and swelling along the inside of the ankle and arch during or after activity — long walks, pickleball, standing all day — that settles with rest. The tendon sheath produces excess fluid as it tries to heal, which is the soft swelling you can see and feel behind the inner ankle bone. As the condition progresses, pain appears even at rest, the tendon weakens, and the arch begins to visibly flatten while the heel drifts outward. In advanced cases the tendon partially or completely tears. A simple self-check: try rising onto your tiptoes on one foot. If the painful side is weak, painful, or you cannot lift the heel at all, the tendon is failing and needs prompt evaluation.
Posterior tibial tendonitis is a staged disease. Stage 1 (inflamed but intact tendon) responds very well to orthotics, bracing, and therapy. By the time the arch has collapsed and stiffened, the same problem requires reconstructive surgery with months of recovery. The difference between those two outcomes is usually how early the patient came in. At your visit we examine tendon strength and alignment, and use on-site musculoskeletal ultrasound — and MRI when needed — to grade exactly how much tendon damage exists, which directly determines your treatment plan.
Conservative care resolves most early cases. We offload the tendon with custom orthotics engineered to support your specific arch mechanics, or an ankle brace for more advanced weakness. This is combined with activity modification, anti-inflammatory treatment, and targeted physical therapy — available in-house — to progressively strengthen the tendon. Significantly irritated tendons benefit from a walking boot for 4 to 6 weeks of protected rest. For stubborn chronic tendinopathy, shockwave therapy stimulates the tendon’s own healing response without injections or downtime. Cortisone is used only rarely and cautiously around this tendon, because it can weaken tissue that is already failing.
When surgery is needed, the procedure matches the stage: cleaning and repairing a damaged but functional tendon in earlier disease, or tendon transfer with realignment of the heel bone and arch (flatfoot reconstruction) once collapse has occurred. Our fellowship-trained surgeons perform the full spectrum of these procedures, and we will always tell you honestly whether you actually need surgery — most patients do not.
Family Foot & Leg Center has treated Southwest Florida’s tendon and flatfoot conditions since 2005 under Dr. Kevin Lam, DPM, FACFAS, DABLES, DABPS — named among America’s Top Podiatrists, trained at Mount Sinai Medical Center and Jackson Memorial Health. On-site ultrasound, digital X-ray, in-house physical therapy, shockwave therapy, and 9 offices from Marco Island to Sarasota mean you get diagnosis and a complete plan in one place, usually with same-day or next-day availability.
Aching pain and swelling on the inside of the ankle behind the ankle bone, worse with activity, sometimes spreading into the arch. Pain or weakness rising onto tiptoes on one foot is a hallmark sign.
Yes. Untreated, it progresses to posterior tibial tendon dysfunction — the number one cause of adult-acquired flatfoot. Early treatment is dramatically simpler than late treatment.
Custom orthotics or bracing, activity modification, physical therapy, a walking boot when needed, and shockwave therapy for chronic cases. Most early-stage patients never need surgery.
When conservative care fails, the tendon tears, or the arch has structurally collapsed. Procedures range from tendon repair to full flatfoot reconstruction, performed by our board-certified surgeons.
Any of our 9 offices across Naples, Estero, Fort Myers, Cape Coral, Port Charlotte, and Sarasota — same-day appointments usually available.
Inner ankle pain and a flattening arch will not fix themselves. Call (239) 430-3668 or book your appointment online 24/7.
Family Foot and Leg Center, PA — Podiatrist Naples FL | Foot Surgery | Heel Pain | Bunion Treatment | Diabetic Foot Care | Sports Podiatry | Serving Marco Island, Naples, Bonita Springs, Fort Myers, Cape Coral, Port Charlotte & Sarasota.
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