Clinical tests of tibialis posterior tendinopathy: are they reliable, and how well are they reflected in structural changes on imaging?

Review written by Dr Melinda Smith info

Key Points

  1. Clinical tests for tibialis posterior tendinopathy demonstrated moderate to substantial reliability, and small to moderate associations with ultrasound imaging findings.
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In the tendinopathy (and broader) literature, the relationship between imaging findings and clinical signs has been a contentious topic for some time. Recently, the International Scientific Clinical Symposium consensus on clinical terminology concluded that “imaging is not always necessary for a diagnosis of tendinopathy” (1).

Ultrasound imaging is commonly used to assess tendon changes, but how this relates to common clinical tests has not been explored for tibialis posterior tendinopathy (TPT). The aims of this study were to:

  1. determine the reliability of common clinical tests for TPT; and
  2. investigate the relationship between ultrasound imaging findings and clinical tests for TPT in individuals with medial foot/ankle pain.

Imaging is not always necessary for a diagnosis of tendinopathy.
Imaging findings should be considered together with clinical presentation and not in isolation.


This prospective cohort study recruited 52 participants with medial foot/ankle pain. Four clinical examination tests for TPT were performed by two physical therapists and an ultrasound examination was performed by a sonographer. All examiners were blinded to each other’s findings.

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