Tibialis Posterior

Original Editor - Michelle Lee Top Contributors - Rucha Gadgil and Kim Jackson  

Description[edit | edit source]


The Tibialis Posterior is located deep in the posterior compartment of the lower leg and situated between the Flexor Digitorium Longus and the Flexor Hallucis Longus. It is a key stabilising muscle supporting the medial arch of the foot.

Origin[edit | edit source]

The origin of the muscle is[1]:

Proximal postero-lateral aspect of the tibia.

Proximal postero-medial aspect of the fibula and the interosseous membrane

Mid portion: Situated in the deep posterior compartment of the lower leg and runs proximal to the medial malleoli where it is secured by the flexor retinaculum.

Insertion[edit | edit source]

The major insertion is onto the navicular and the plantar slip attaches to the medial cuneiform bone[1].

Nerve[edit | edit source]

Tibial Nerve (L4-S3)[1]

Artery[edit | edit source]

Tibial Artery[1]

Function[edit | edit source]

To plantarflex and invert the ankle. It also plays an important role in stabilising the medial longitudinal arch. Tibialis posterior dysfunction can lead to flat feet and weak arch control in adults.


Clinical relevance[edit | edit source]

  • In foot drop (High steppage gait) as a result of deep peroneal nerve palsy, transferring the posterior tibialis tendon to the dorsum of the foot is a surgical tendon transfer procedure carried out to compensate for the loss of dorsiflexion due to tibialis anterior paralysis.[4]

Assessment[edit | edit source]

Assessment of Muscle strength[5]
Palpation Of Tibialis Posterior[6]

Treatment[edit | edit source]

Strengthening:[edit | edit source]

Strengthening of the tibialis posterior muscle can be done in multiple positions. Strengthening will also improve the arch control of the foot. It can be started after assessing the muscle strength of the individual manually. It proves beneficial for preventing or treating conditions associated with a weakness of this muscle.

The positions of strengthening can be :

  1. Supine
  2. Sitting
  3. Standing

Strengthening can also be done in functional positions. In order to isolate the Tibialis Posterior muscle for strengthening, plantarflexion with inversion movement has to be encouraged.

Different Equipment can be used to assist in strengthening like therabands, weights etc.

The following video can give an idea about strengthening of the Posterior Tibialis Muscle[7].

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 Drake RL, Vogl W, Mitchell AWM. Gray's Anatomy for Students. 2nd Ed. Philadelphia: Churchill Livingstone Elsevier, 2010.
  2. Nabil Ebraheim. Anatomy Of The Tibialis Posterior Muscle - Everything You Need To Know - Dr. Nabil Ebraheim. Available from: https://www.youtube.com/watch?v=9N_eR8Pojuw [last accessed: 25/6/18]
  3. Semple R, Murley GS, Woodburn J, Turner DE. Tibialis posterior in health and disease: a review of structure and function with specific reference to electromyographic studies. J Foot Ankle Res. 2009;2:24. doi: 10.1186/1757-1146-2-24.
  4. Yeganeh A, Motaghi A, Shahhoseini G, Farahini H. New method for fixation point of tibialis posterior tendon transfer. Med J Islam Repub Iran. 2013;27(4):163-167.
  5. Sheena Livingstone. Tibialis Posterior Muscle Test. Available from: http://www.youtube.com/watch?v=7cEJD-9aBTk [last accessed 25/6/18]
  6. PolkStatePTA. Tibialis Posterior. Available from: http://www.youtube.com/watch?v=f-vVv59NNBI [last accessed 25/6/18]
  7. Dr. Leo Karmanik.https://www.youtube.com/watch?v=Yk4ni1ZcLCY