I see several patients on a weekly basis that complain of ankle pain that have no history of recent ankle sprain or any trauma. They describe their pain as sharp and burning on the inside of the ankle with swelling and pain that is worse with walking, but continues as aching pain at rest. Some patients can have so much pain that they are unable to walk without crutches. On exam, I will find that the posterior tibial tendon is swollen and painful usually from behind the ankle bone down to where the tendon inserts in the foot. The job of this tendon is to help the foot swing inward in gait and support the arch. But with flat feet, the tendon is overworked and often then forms small tears in the area just described which then causes pain and swelling. When asking a patient to walk in my office, the affected foot will show minimal to no arch height and the ankle will appear to be falling inward, sometimes almost touching the ground. There is usually pain with isolating this tendon on a muscle exam as well. So how does this really happen? Overuse is the most common mechanism of injury. Wearing flip flops or going barefoot on a regular basis. Starting a vigorous exercise program when you previously were not exercising. Walking a significant amount on a vacation like Disney World when this is unusual for your daily amount of activity. Treatment starts with an evaluation and xrays to ensure you do not have anything else that may be causing your pain and to get a better idea of your bone and joint structure. Next, rest, ice and compression are the key to getting your swelling and pain under control. In severe cases, bracing may be necessary to achieve this goal. Once your pain and swelling have resolved, the next thing you need to do is prevent this from happening again. The best way to do that is wear good supportive shoe gear and be fitted for custom orthotics. Without preventative care, this tendonitis can because a chronic dysfunction of the foot and ankle requiring surgical reconstruction. If you think you may have this condition, the physicians at Foot and Ankle Associates of North Texas are here to help!