Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
The tibialis posterior tendon and spring ligament complex form the primary static and dynamic support system of the medial longitudinal arch and are the central anatomical structures whose failure produces adult acquired flatfoot deformity (AAFD). Understanding the anatomy and biomechanical function of these structures is fundamental to understanding why posterior tibial tendon dysfunction (PTTD) produces the characteristic triplanar flatfoot deformity and why surgical reconstruction must address each component of this complex.
Tibialis Posterior Tendon
The tibialis posterior muscle — originating from the posterior interosseous membrane and adjacent fibula and tibia — is the deepest muscle of the deep posterior compartment of the leg. Its tendon passes posterior to the medial malleolus in a fibro-osseous tunnel (the tarsal tunnel, where it is the most medial of the three deep posterior tendons: TP, FDL, FHL running medial to lateral). Distal insertions: the tibialis posterior tendon fans out into multiple insertions — the primary insertion is at the navicular tuberosity; secondary insertions spread to the plantar surface of all three cuneiforms, the cuboid, and the bases of the second through fourth metatarsals. This broad plantar insertion makes the tibialis posterior the primary supinator of the subtalar joint — during heel rise and push-off, tibialis posterior contraction locks the subtalar joint in inversion, converting the flexible midfoot into a rigid lever for push-off. Loss of tibialis posterior function eliminates this locking mechanism — the midfoot pronates through push-off, spreading the arch and producing the progressive deformity of Stage II PTTD.
Spring Ligament Complex
The spring ligament (plantar calcaneonavicular ligament) complex — comprising the superomedial and inferior calcaneonavicular ligaments — spans from the sustentaculum tali of the calcaneus to the navicular, supporting the head of the talus from below and medially. The spring ligament functions as a sling for the talar head — it bears the body weight transmitted through the talus during midstance and prevents medial talar head descent (which produces arch collapse). MRI of spring ligament tears: the spring ligament is routinely evaluated on MRI in PTTD — spring ligament tears are present in 60–70% of Stage II PTTD cases and correlate with severity of flatfoot deformity; isolated spring ligament reconstruction is an emerging technique that may reduce the need for calcaneal osteotomy in selective cases. Dr. Biernacki at Balance Foot & Ankle evaluates flatfoot deformity with weight-bearing X-ray and MRI of the tibialis posterior tendon and spring ligament complex to guide reconstruction planning. Call (810) 206-1402 at our Bloomfield Hills or Howell office.
📧 Get Dr. Tom’s Free Lab Test Guide
Discover the 5 lab tests every person over 35 should ask their doctor about — explained in plain English by a board-certified physician.
📍 Located in Michigan?
Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Frequently Asked Questions
When should I see a podiatrist?
See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.
What does a podiatrist treat?
Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.
What can I expect at my first podiatry visit?
Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a personalized treatment plan. Most visits take 30–45 minutes.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
Book Online or call (810) 206-1402
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
Get Directions →
Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
Get Directions →
Your Board-Certified Podiatrists
Ready to Get Back on Your Feet?
Same-week appointments available at both locations.
Book Your Appointment
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
Treatment Options Available at Our Office