Focused Shockwave Therapy for Posterior Tibial Tendinopathy

Posterior tibial tendinopathy, also known as posterior tibial tendon dysfunction (PTTD), is the leading cause of adult-acquired flatfoot. The condition typically begins with medial ankle pain and may progress to tendon degeneration and collapse of the medial longitudinal arch if not recognized early. The posterior tibialis muscle functions as the primary dynamic stabilizer of the arch, especially during push-off in walking and running.

Repetitive strain that exceeds the tendon’s tolerance initiates a progression from irritation to failed healing, fibrosis, and degeneration. The most common site of pathology is a relatively hypovascular region just behind the medial malleolus. Early-stage disease (Stage I and II) remains flexible and is usually appropriate for conservative care, while advanced stages (Stage III and IV) involve rigid deformity, ligament compromise, and potential need for surgical intervention.

Because posterior tibial tendinopathy reflects degenerative tendon pathology rather than persistent inflammation, treatment focuses on restoring tendon capacity, improving mechanical support, and stimulating tissue remodeling. Focused Shockwave Therapy is a non-invasive modality that may be incorporated into conservative management for early-stage degenerative tendon conditions when clinically appropriate.