Tibialis Posterior Rupture Guide 2026 | DPM

What Happens When the Tibialis Posterior Tendon Ruptures

The tibialis posterior tendon is the primary dynamic support of the medial arch. A complete rupture causes the arch to progressively collapse, the heel to drift outward (valgus), and the forefoot to abduct — creating the classic “too many toes” sign when viewed from behind. This is called adult acquired flatfoot deformity (AAFD).

Stages of AAFD from Tibialis Posterior Rupture

Stage I: Tendinitis and partial tear — flexible flatfoot, no deformity yet. Stage II: Complete rupture — flexible flatfoot with deformity, passively correctable. Stage III: Fixed flatfoot — deformity is rigid, subtalar joint involvement. Stage IV: Ankle involvement — valgus tilt of the ankle joint. Treatment strategy depends heavily on stage.

Symptoms

Pain and swelling along the inner ankle and arch, difficulty with single-leg heel raise (hallmark test — inability to raise the heel is diagnostic), progressive flat foot deformity, and aching fatigue with prolonged standing or walking.

Non-Surgical Treatment (Stage I–II)

Orthotics with medial arch and heel varus posting, UCBL or custom AFO bracing, physical therapy for strengthening, and activity modification. Many Stage I patients and some Stage II patients do well with long-term bracing.

Surgical Treatment (Stage II–IV)

Stage II surgery: FDL tendon transfer (to replace tibialis posterior function) + calcaneal osteotomy (to shift the heel from valgus to neutral) ± medial column procedures. Stage III: Subtalar or triple arthrodesis (fusion). Stage IV: Ankle fusion or total ankle replacement plus subtalar fusion.

FAQs

Can a ruptured tibialis posterior tendon heal on its own? No. Once ruptured, it does not spontaneously repair. Management focuses on compensating for lost function through bracing or surgical reconstruction.

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In-Office Treatment at Balance Foot & Ankle

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