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Arch Collapse (Tibialis Posterior Dysfunction)

Have you ever wondered if your arches are flattening? Is it one foot or both?
You’re probably not imaging this! It does happen to a mild degree over a lifetime.
Subtle changes with arch height and shape can occur over the years.

Sometimes, however, a change in arch height can reflect a more serious issue.
When structural ligament injury occurs the condition is called Posterior Tibial Dysfunction.
It doesn’t always result from injury either, it can just occur with degeneration over time.

If you’re concerned about your arch flattening you must read on…

If you have true Posterior Tibial Dysfunction when left untreated it can result in a flat, rigid foot which means over time a stiff ankle, knee and hip with painful gait changes!

What Is Posterior Tibial Dysfunction?

Posterior Tibial Dysfunction is the term used when the Posterior Tibial Tendon is unable to perform its function. The muscle as shown, starts from deep within the calf and comes down the inside of the ankle, leading to many insertion points into the foot. When the muscle is working and contracting it is a big driver for a strong and powerful foot! The main role of this muscle and tendon is to simply lift the arch up.

Key roles of Posterior Tibial Muscle:

  • Foot Stabilisation
  • Turns foot inward and points toes down
  • Allows us to go up on our toes
  • Supports the arch of the foot

Why does this powerful foot muscle become weak suddenly?

There can be a whole myriad of reasons why the foot can flatten. Sometimes a foot may be predisposed to this occuring, if it already rolls or rotates in significantly meaning years of more strain or pressure on the muscle. Other times an acute injury such as a roll or sprain can damage the arch ligaments (spring ligament or Plantar Fascia) which work as a team to support the muscle. Check out the anatomy of the spring ligament below. Other times due to pure overuse the tendon can become inflammed and without correct treatment, can leave the tendon overstretched and weak, never healing back to 100%.

What does it feel like?

Typical symptoms and sensations can include:

  • Pain, swelling or warmth inside the ankle or foot
  • Flattening of the arch
  • Shin pain (big toe side of shin)
  • Arch Collapse Condition

Typical Progressions Of Posterior Tibial Dysfunction

Often being referred to as a progressive condition, this means that the symptoms change the longerthe condition is present.

Here are a list of the typical stages seen:

  1. Initial stage – typically there is pain on the inside of the foot and ankle (along the tendon), which may be accompanied by swelling
  2. Later stages: there may still be pain on the inside of the foot and ankle as the arch flattens and foot and toes begin to turn outward and the ankle rolls inward
  3. Advanced stages – the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. This is due to the large amount of rotation with subsequent impingement on the outside ankle. The condition may progress to a point where the tendon may tear completely. This results in an extremely flat foot that is difficult to fit into footwear and can be very painful ongoing.


With appropriate and rapid treatment, the progression of this condition can be slowed considerably or in some cases even stopped. Depending on the stage of the acuteness of the case, treatment can vary but can include the following:

  • Taping
  • Orthotic Therapy
  • Strengthening Exercises
  • Bracing
  • Footwear Recommendations
  • Surgical if conservative methods exhausted


An example of Posterior Tibial Strengthening exercises. It is important that exercises are closely monitored to not cause further damage, but to guide a healthy exercise program that will strengthen the muscle and tendon gradually over time.

Your Podiatrist may even start with banded work if standing exercises are too much early on.

Are you concerned your foot arch is flattening?
It may be a natural change OR it could be something more serious.
Get it checked out by a Podiatrist ASAP to prevent long term problems!

Do you need your foot & ankle pain fixed fast?

Pod Fit Podiatry Adelaide are here to help! Booking online is the most convenient way to lock in the location, practitioner & time you want. We look forward to seeing you in the clinic.