Tibialis Posterior Muscle

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Figure 1: Muscles of the lower leg¹

Figure 2: Superficial posterior leg muscles²

Deep posterior leg muscles²

The Mucous sheaths of the tendons around the ankle (medial view)²

1st layer of the plantar foot²

2nd layer of the plantar foot²

3rd layer of the plantar foot²

Reading list

• Ch67 Tibialis posterior muscle³
• Neuman⁴
• MMT⁵

Muscle	Origin	Insertion	Innervation	Action
Tibialis posterior	IO membrane Adjacent Tibia Adjacent Fibula	Cuneiforms 2-4 MT bases	Tibial n. L4 - L5	TCJ: PF Arch support: Transverse arch, Longitudinal arch

Origin

• IO membrane⁶
• Tibia (adjacent border)⁶
• Fibula (adjacent border)⁶

Insertion

• Navicular tuberosity⁶
• Cuneiforms (medial, intermediate, and lateral)⁶
• Bases of metatarsals 2-4⁶

Nerve

Tibial N. (L4, L5)⁶

Action

• TCJ: Plantarflexion⁶
• STJ: Inversion (supination)⁶
• Longitudinal Arch: Support⁶
• Transverse Arch: Support⁶

The posterior tibialis and flexor hallucis longus also improves the stability of ankle joint by creating a dynamic pinch between the malleoli, which improves joint contact during plantarflexio⁷.

Tendon

“This tendon is palpable at the level of the medial malleolus, especially with the foot held in plantar flexion and supination. Distal and medial to this tendon, the crossing of the FDL and flexor hallucis tendons can be felt.”⁸

Examination

Strength Testing

“The tibialis posterior muscle produces the motion of inversion in a plantar flexed position. The leg is stabilized in the anatomic position, with the ankle in slight plantar flexion. The plantar flexion is important to minimize the influence of the tibialis anterior muscle.77 Resistance is applied to the medial border of the forefoot into eversion and dorsiflexion (Fig. 21-24) VIDEO. The standing heel raise test can also be used to detect tibialis posterior weakness. It is thought that during a standing heel rise that the tibialis posterior and fibularis muscles co-contract to control hindfoot position. Thus, when the hindfoot everts during the heel-rise task, this is seen as a clinical sign of tibialis posterior weakness.”⁸

Dysfunction

Tibialis Posterior tendonitis

Myofascial release

Pails & Rails

P.A.I.L.’s

• Plantarflexion
• Inversion

R.A.I.L.’s

• Extension
• Eversion

Stretch

• 3D Calf Stretch

Shin splints

Tibialis posterior dysfunction can lead to shin splints, more specifically posterior shin splints.

References

1.

Betts JG, Blaker W. Anatomy and Physiology. 2nd ed. OpenStax; 2022. https://openstax.org/details/books/anatomy-and-physiology-2e/?Book%20details

2.

Gray H. Anatomy of the Human Body. 20th ed. (Lewis WH, ed.). Lea & Febiger; 1918. https://www.bartleby.com/107/

3.

Donnelly JM, Simons DG, eds. Travell, Simons & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Third edition. Wolters Kluwer Health; 2019.

4.

Neumann DA, Kelly ER, Kiefer CL, Martens K, Grosz CM. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 3rd ed. Elsevier; 2017.

5.

Weinstock D. NeuroKinetic Therapy: An Innovative Approach to Manual Muscle Testing. North Atlantic Books; 2010.

6.

Gilroy AM, MacPherson BR, Wikenheiser JC, Voll MM, Wesker K, Schünke M, eds. Atlas of Anatomy. 4th ed. Thieme; 2020.

7.

Jones B. B Project Foundations. b Project; 2025.

8.

Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 5th ed. McGraw Hill Education; 2020.