Section 01 of 20
Introduction
Tibialis posterior lies in the deep posterior compartment of the leg, between the tibia and fibula, beneath the more superficial soleus and gastrocnemius. Its long tendon passes behind the medial malleolus (the bony bump on the inner ankle) and fans out to attach to several bones on the underside of the foot.
Its wide, fan-shaped insertion makes it an important support for the medial longitudinal arch of the foot, in addition to its role in moving the ankle and foot.
Section 02 of 20
Origin
| Origin | The posterior surfaces of the tibia and fibula and the interosseous membrane between them. |
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An anatomical image for this section will be added when verified source media becomes available.
Section 03 of 20
Insertion
| Insertion | Mainly the navicular tuberosity and the medial cuneiform, with additional slips to the middle and lateral cuneiforms, the cuboid, and the bases of the second through fourth metatarsals. |
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An anatomical image for this section will be added when verified source media becomes available.
Section 04 of 20
Actions
| Primary action | Plantar flexion of the ankle. |
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| Secondary actions | Inversion of the foot and support of the medial longitudinal arch. |
| Movement at the joint | Ankle (talocrural) and subtalar and midtarsal joints. |
| Heads / fiber groups | Single muscle with a broad, fan-shaped distal tendon. |
| Functional examples | Walking and running (push-off); standing (arch support); walking on uneven ground. |
Plantar flexion of the ankle
Points the foot downward, assisting gastrocnemius and soleus.
Inversion of the foot
Turns the sole of the foot inward.
Support of the medial longitudinal arch
Its broad tendon helps hold up the arch of the foot during standing and walking.
Section 05 of 20
Nerve Innervation
| Nerve | Tibial nerve, roots L4–L5. |
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The tibial nerve and posterior tibial vessels run through the deep posterior compartment near this muscle, and its tendon passes through the tarsal tunnel behind the medial malleolus alongside the same nerve. Numbness in the sole of the foot, or pain that spreads into the foot, may reflect nerve involvement, not only muscle tightness.
Section 06 of 20
Blood Supply
| Blood | The posterior tibial artery. |
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Section 07 of 20
Pictures and Visual Anatomy
An anatomical image for this section will be added when verified source media becomes available.
Section 08 of 20
Functional Movement
Tibialis posterior is active in every step of walking and running, especially during the push-off phase, and it works continuously to support the arch of the foot during standing. It is also used when walking on uneven ground, which demands foot inversion for balance.
Section 09 of 20
Synergists and Antagonists
Synergists: gastrocnemius and soleus (plantar flexion), and tibialis anterior (inversion). Antagonists: the fibularis (peroneus) longus and brevis (eversion), and tibialis anterior and the toe extensors (dorsiflexion).
Section 10 of 20
Palpation and Location
Client position and technique
Position the client prone with the foot relaxed off the end of the table, or supine with the leg supported. Because it is deep to gastrocnemius and soleus, it is easiest to feel its tendon just behind and below the medial malleolus. Ask the client to invert the foot against light resistance to feel the tendon tighten.
Protect nearby structures
The posterior tibial vessels, tibial nerve, and flexor tendons run close to tibialis posterior's tendon behind the medial malleolus, in the tarsal tunnel. Use light pressure in this area, avoid sustained compression, and stop if the client reports numbness, tingling, or sharp pain in the foot.
Section 11 of 20
Massage Therapy Relevance
Tibialis posterior is central to arch support, and its dysfunction is a leading cause of acquired flatfoot in adults, especially with age and activity. Foot and ankle pain in this area has several possible causes, so careful assessment is useful.
Section 12 of 20
Dysfunction: What Happens When Movement Goes Wrong
Changes in how a muscle works can change how a joint moves. The points below describe possibilities that may be associated with altered muscle function; they are not diagnoses, and one muscle is never assumed to be the sole cause of a problem.
When the muscle is weak
Weakness or tendon dysfunction may be associated with a gradually flattening arch and a foot that rolls inward (overpronation).
When it is tight or shortened
Tightness may be associated with limited eversion and dorsiflexion and a feeling of deep calf or inner ankle tightness.
When it is overused
Running, walking on uneven surfaces, and prolonged standing may overload the muscle and tendon and may contribute to medial ankle or shin pain.
When it is strained
A strain or tendinopathy may cause pain behind the medial ankle with push-off; ankle joint and nerve problems can look similar.
When it is inhibited or others compensate
Reduced activation may be associated with reduced arch support and altered foot mechanics during gait.
When it does not coordinate well with synergists and antagonists
Poor coordination with the other calf and foot muscles may alter gait mechanics and may be associated with foot, ankle, or shin symptoms.
Section 13 of 20
Conditions, Pathologies, and Pain Relationships
Tibialis posterior tendinopathy and dysfunction
Overuse or gradual degeneration of the tendon may cause pain behind the medial ankle and a gradually flattening arch, sometimes progressing to adult-acquired flatfoot.
Shin splints (medial tibial stress syndrome)
Repetitive loading may cause pain along the inner shin, which can involve tibialis posterior and the surrounding tissue.
Tarsal tunnel syndrome
Compression of the tibial nerve near the medial ankle may cause pain, numbness, or tingling in the sole of the foot.
Differential considerations
Stress fractures, ankle joint problems, plantar fasciitis, and lumbar nerve referral can all cause similar medial ankle and foot symptoms.
Section 14 of 20
Example Clinical Relationship
A middle-aged client who walks for exercise reports gradual inner-ankle pain and a sense that the arch of the foot is flattening over several months. Tibialis posterior tendon dysfunction may be involved, and the pattern may be associated with tendinopathy, but ankle joint and nerve problems can look similar and need assessment. Gentle work on the calf may support comfort, while a sudden inability to rise onto the toes or a rapidly flattening arch needs referral.
Section 15 of 20
Massage and Treatment Approaches
For healthy, non-acute tissue, position the client prone or supine with the leg supported. Begin with light effleurage over the calf, then use gentle kneading through the more superficial calf muscles and lighter pressure over the tendon behind the medial malleolus, staying within comfortable pressure.
| Movement | Use gentle ankle eversion and dorsiflexion stretches within comfort; do not force range. |
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| Regional work | Consider gastrocnemius, soleus, flexor digitorum longus, and the plantar fascia when assessment supports it. |
| Avoid | Deep or sustained pressure behind the medial malleolus (tarsal tunnel), over a swollen or acutely painful tendon, or at any point that reproduces foot numbness or tingling. |
Section 16 of 20
Precautions and Contraindications
Precautions and contraindications
- Acute ankle or calf injury, suspected tendon tear, or recent leg, ankle, or foot surgery.
- Use caution with known tibialis posterior dysfunction or a progressively flattening arch; deep friction is not appropriate for an irritable tendon.
- Use caution with anticoagulant use or easy bruising.
- Stop if pressure causes numbness, tingling, or sharp pain in the foot.
Section 17 of 20
Red Flags and When to Refer
Red flags and referral
- A sudden inability to rise onto the toes on one side, or a rapidly flattening arch with pain (possible tendon rupture).
- A swollen, warm, red, or painful calf, especially on one side (possible blood clot).
- Numbness or tingling in the sole of the foot that is progressive.
- Foot or ankle pain with fever, night pain, or unexplained weight loss.
Section 18 of 20
Study Summary
Attachments
Origin: posterior tibia, fibula, and interosseous membrane. Insertion: navicular, cuneiforms, cuboid, and metatarsals 2–4.
Actions
Plantar flexion and inversion; supports the medial longitudinal arch.
Supply
Tibial nerve (L4–L5); posterior tibial artery.
Section 19 of 20
Instructor Narration
Open narration transcript
Tibialis posterior is the deepest muscle of the calf, lying between the tibia and fibula beneath gastrocnemius and soleus.
It arises from the posterior tibia, fibula, and the interosseous membrane, and inserts mainly on the navicular and medial cuneiform, with slips to nearby foot bones.
It plantar flexes and inverts the foot and supports the arch of the foot. Gastrocnemius and soleus help with plantar flexion, and the fibularis muscles and toe extensors oppose it.
The tibial nerve supplies it, from L4 to L5, and the posterior tibial artery provides its blood.
Its tendon is easiest to feel just behind and below the medial malleolus, with the foot gently inverted against resistance. Use light pressure in this area, since the tibial nerve and vessels run close by.
Tendinopathy and dysfunction, shin splints, and tarsal tunnel syndrome are common, and stress fractures and ankle joint problems can overlap. Refer a sudden inability to rise onto the toes with a flattening arch, a swollen warm calf, or progressive numbness in the sole of the foot.
Remember: posterior tibia and fibula to the navicular and cuneiforms; plantar flexion and inversion; tibial nerve.
Section 20 of 20