Tibialis Posterior: Pain Pattern and Treatment
The tibialis posterior is the deepest muscle of the calf, lying against the back of the shin bones and sending its tendon behind the inner ankle to the arch. It holds the arch up with every step. Its documented pattern is pain centered over the Achilles tendon above the heel, spreading up into the calf and down across the heel and sole. It is the muscle behind an "Achilles tendinitis" that tendon treatment does not fix, and it is worst on uneven ground.
Attachments and action
Origin: The back of the interosseous membrane and the adjacent surfaces of the tibia and fibula.
Insertion: The navicular tuberosity, with slips to the cuneiforms, the cuboid, and the bases of the second through fourth metatarsals.
Action: Inversion of the foot and plantar flexion of the ankle; it is the main support of the arch during walking.
Where the pain is felt: Over the Achilles tendon above the heel. Up into the middle of the calf. Down into the heel and across the sole to the toes. Worst walking or running on uneven ground.
Common causes: Running on cambered roads or trails; flat feet that roll inward; worn shoes; a sudden increase in mileage; a long walk on sand or gravel; standing on a ladder rung.
Patients say: "They called it Achilles tendinitis but the tendon treatment did nothing." "Uneven ground is the worst." An ache in the arch and the sole after walking. A calf that feels deep, not on the surface.
When to get evaluated: A sudden snap at the back of the ankle with weakness pushing off needs an Achilles rupture ruled out. Calf pain with swelling, warmth, or redness needs a blood clot ruled out first. A collapsing arch with swelling behind the inner ankle needs the tibialis posterior tendon itself assessed.
How this muscle is examined and treated
Examination watches the arch in standing and walking, tests inversion against resistance, and presses deep through the calf for the point that reproduces the tendon pain. Needling here addresses the muscle deep in the calf, between the shin bones, with the approach chosen for the vessels that run beside it. Assessment and treatment happen in the same visit.
Related conditions
Ankle & Foot PainSports & Performance InjuriesChronic Pain Patterns
Treatment points: KI3 Taixi
This page is educational. It describes muscle referral patterns commonly associated with pain; it does not diagnose your condition. Individual patterns vary. For evaluation of your specific pain, see a licensed clinician. Seek immediate medical care for emergencies. Eugene Baek, L.Ac. · New Jersey License 25MZ00080600