It is now known that the problem is caused by a degenerative tendinosis rather than inflammation. Inflammation when it does occur is secondary. The patient may also experience pain and swelling right behind the inner ankle bone. There is pain upon palpation along the course of the posterior tibial tendon behind the inner ankle. There may also be burning, shooting, tingling, stabbing pain , because the nerve is inflamed inside the tarsal tunnel.
Patients experience significant pain when walking, steadily worsening toward the end of the day.
In some cases the tendon may actually rupture or tear, due to weakening of the tendon by the inflammatory process. The patient is viewed standing from behind. The amount of heel valgus on the affected side is noted. The patient is then asked to stand on his toes. The heel should invert upon standing in the normal foot without posterior tibial tendon dysfunction.