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Everything You Need To Know About Lower Leg Injuries

Posted on 5 September 2015
Everything You Need To Know About Lower Leg Injuries

The Tibialis posterior muscle is a lower leg muscle that is involved in both movement and stability, and is commonly implicated in ankle pain.

The Anatomy of the Tibialis Posterior

The tibialis posterior begins in between the shinbones, the tibia and fibula. It continues down toward the inner ankle bone, known as the medial malleoli, and ends attaching to many of the foot bones (metatarsals two through four, second and third cuneiform, cuboid, navicular, and plantar surface of first cuneiform). It's main action is to turn the foot inward (inversion) and to point to foot downward (plantar flexion). It also plays a pivotal role in maintaining the inner arch of the foot -- known as the medial longitudinal arch.

Types of Lower Leg Muscle Injuries

Tibialis posterior can be injured both traumatically and atraumatically.

The most common traumatic injury to the lower leg muscle is a partial tear or full rupture to the tendon. This commonly happens when landing forcefully on an everted ankle (ankle and foot turned inward). A full rupture has a higher likelihood of occurring in people that have suffered previous eversion sprains and / or the co-existence of tibialis posterior tendonsis.

Acute tibialis posterior injuries characterized by sharp pains behind the medial malleoli (the inner ankle bone) or sharp pains in the inner calf. Those with acute tibialis posterior injury often present with a very flat foot that they often cannot actively correct, as well as pain going onto their toes.

Often times, acute injury to the lower leg muscle is found in conjunction with both capsular and ligamentous injury to the medial ankle structures, with a possibility of fracture to the inner ankle bone.

Atraumatic or chronic injuries to the tibialis posterior are caused from injuries resulting in tendonitis (inflammation of the tendon) or tendonosis (gradual breakdown of the tendon). This occurs when the muscle has insufficient strength to withstand the demands being placed on it. This is often seen in individuals who have flat feet.

Those with chronic tibialis posterior injuries experience soreness behind the medial malleoli, often an ache at rest and tenderness at touch behind the inner ankle bone. They are often able to continue day to day tasks, sometimes even sport-related tasks, but find increased ache post training, sometimes swelling which appears as 'puffiness' behind the inner ankle bone, and often a feeling of tightness first thing in the morning. This pattern of pain occurs over time, typically worsening over the course of months.

How to Treat Lower Leg Muscle Pain

With early and proper detection, tibialis posterior injuries can be treated so that you can get back to your daily activities and sports pain free.  In the acute stages from traumatic injury, ruling out other injuries and protecting the area is essential. This may involve diagnostic imagery or the completion of special tests during a thorough assessment. Treatment at this stage would consist of supporting and protecting the ankle while maintaining as much movement and function as possible.

In the chronic overuse tibialis posterior injuries, treatment may consist of strengthening the ankle and establishing correct biomechanical gate patterns. Furthermore, there is evidence that supports using platelet rich plasma therapy and shockwave therapy in chronic cases of tibialis posterior injures.

Our knowledgeable rehabilitation team at SEMI can help with both detection through a thorough assessment, and a multidisciplinary treatment approach with may consist of collaboration between our Sport Medicine Physician and physiotherapy, chiropractics, massage and podiatry. If you're suffering from lower leg muscle pain or ankle pain, the SEMI team can provide the correct treatments so you can return to the daily activities you enjoy. Contact us today!



  1. Ribbans WJ, Garde A. Tibialis posterior tendon and deltoid and spring ligament injuries in the elite athlete. Foot Ankle Clin. 2013 Jun;18(2):255-91.
  2. Howitt  S, Jung S,  Hammonds N. Conservative treatment of a tibialis posterior strain in a novice triathlete: a case report. J Can Chiropr Assoc. Mar 2009; 53(1): 2331.
  3. Magee, D. Lower leg, ankle and foot. In Orthopedic Physical Assessment2008. (5th ed., p. Ch. 13). Missouri: Saunders Elseiver.a
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