Pain on the inside of the ankle or foot arch (tibialis posterior tendinopathy)
Why the inside of the ankle and arch of the foot can hurt, how it relates to flat feet, how long it takes to improve, and what helps.
The tibialis posterior tendon runs down the inside of the lower leg, behind the inside ankle bone, and helps support the arch of the foot. An NHS leaflet describes tibialis posterior tendinopathy as a condition where this tendon becomes irritated or struggles to cope with load. It is a common cause of inner ankle and arch pain, especially in people on their feet a lot or who have recently stepped up walking or running.
When to get urgent help
Go to A&E or call 999 if you have any of these. They can be signs of a fracture, infection, blood clot or other emergency.
- A limb that looks deformed, or a joint that you cannot move or put weight on after an injury
- A cold, pale or numb foot or hand after injury
- A hot, red, swollen joint with a high temperature
- A painful, swollen, warm calf, with or without breathlessness or chest pain
What it can feel like
- Pain and swelling behind the inside ankle bone and along the inside of the foot, worse when standing or walking
- Difficulty with running, high-impact activity, or long periods on your feet
- A gradual flattening of the foot arch, which can cause pain on the outside of the foot and ankle
- In later stages, being unable to stand on one leg and rise up onto the toes
Common contributors
- Usually a rise in activity or repeated loading, such as more walking or running
- Risk factors in the leaflet include flat feet or shallow arches, older age, obesity, diabetes and certain inflammatory conditions
- It is more often seen in women over 40, though men can be affected too
General self-care
These are general comfort measures many people find reasonable. They are not a treatment plan, and what suits one person may not suit another.
- Rest from high-impact activity and avoid excessive standing or walking until symptoms settle
- Ice wrapped in a towel for 10 to 20 minutes, with at least two hours between applications, can ease pain
- Wear supportive boots or shoes that support the arch and ankle if you are on your feet for long periods, and avoid unsupportive footwear such as flip-flops
- Strengthening is the first-line treatment. The leaflet describes home exercises such as arch lifts, small squats and heel raises, built up gradually, ideally with a physiotherapist's guidance
- If you use over-the-counter pain relief, check with a pharmacist
When to see your GP
See your GP promptly, or call NHS 111, if you have any of the following:
- Pain after a significant injury, fall or twist
- Pain that is constant, severe or getting worse, or wakes you at night
- Unexplained weight loss, fever or feeling generally unwell with limb pain
Consider seeing your GP if:
- Pain and swelling that is not improving, or you notice your arch is flattening or you cannot rise onto your toes
- You have diabetes and a painful foot or ankle
- A hot, red, swollen ankle, pain after a fall or twist, or being unable to put weight on the foot
- A painful, swollen, warm calf, which can be a clot. Seek urgent medical advice
Where an osteopath fits in
There is limited good-quality research showing that hands-on treatment changes the course of inside ankle and arch pain, so I do not claim that osteopathy treats it.
What an osteopath can usefully do is examine your foot, ankle and the way you walk, advise on footwear and activity levels, and guide a graded strengthening programme, which the NHS leaflet describes as the first-line treatment. A podiatrist can advise on insoles. The leaflet says most cases improve with conservative treatment within three to 12 months, and that it does not usually resolve on its own without treatment. If the assessment suggests you need your GP, a physiotherapist or a specialist instead, I will tell you.
If you would like your symptoms assessed, you are welcome to book an appointment. Osteopathic care is not right for everyone, and if something needs medical attention first, I will tell you.
Common questions
Are flat feet the cause of my foot pain?
Flat or shallow arches are a risk factor for this tendon problem, but many people with flat feet have no pain. If the arch is gradually flattening and the inside of the ankle hurts, it is worth having it assessed.
How long does tibialis posterior tendon pain take to settle?
The NHS leaflet says most cases improve with conservative treatment within three to 12 months, and that surgery is rarely needed. Strengthening exercises and sensible footwear are the main approach.
Free 5-minute exercise sheet
A simple, printable sheet of gentle exercises and stretches, about five minutes a day, based on NHS physiotherapy leaflets. It is general information, not a personal treatment plan, and it is not suitable if you have any of the urgent signs listed above.
Sources and further reading
Links open in a new tab. Sources were checked in October 2026.
Related guides
This page is general information to help you understand common aches and pains. It is not medical advice and cannot diagnose your problem. If you are worried about your symptoms, please speak to your GP or call NHS 111.