Case 006 - The Inside Job - Tibialis Posterior Tendonopathy

In Case 006: The Inside Job, Sole Trace investigates the quiet culprit behind medial ankle pain and a collapsing arch: tibialis posterior tendinopathy. It rarely storms in. It creeps—dull ache behind the inside ankle after long runs, morning stiffness that “warms out,” and an arch that looks flatter than it did last season.

This episode flips the usual script: the arch isn’t the villain—it’s the victim. Sole Trace tracks the real offender, the tibialis posterior tendon, and rounds up the main suspects: mileage creep (especially cambered roads/trails), a heavily pronating foot under fatigue, shoe transitions that suddenly shift load medially (minimalist/zero-drop/ditching orthotics), the “sedentary ambush” of collapsing feet all day on hard floors, and systemic risk amplifiers that change the stakes. You’ll hear how he cracks the case with key clinical clues—pinpoint tenderness (behind the medial malleolus vs navicular insertion), the single-leg heel raise (does the heel invert or collapse?), gait signs like “too many toes,” and when imaging is warranted to rule out progression toward rupture and acquired flatfoot.

Sole Trace lays out the evidence-led plan: reduce provocative demand without disappearing, strengthen with slow, progressive tendon loading (isometrics/eccentrics/heavy calf work), rebuild dynamic arch support through foot intrinsics and hip capacity, and manage all-day footwear so rehab actually sticks. Plus, the red flags that mean this isn’t routine tendinopathy and needs urgent assessment.

Feet don’t lie. I just follow the clues.