Underrecognized Subclinical Tibialis Posterior Dysfunction in High-Impact Athlete: A Narrative Review

Abstract

Tibialis posterior dysfunction (TPD) is one of the major cause of adult-acquired flatfoot deformity. It is usually missed during screening of athletes. Among high impact athletes it leads to progressive Tibialis posterior tendon deterioration before any obvious clinical presentation. The aim of this study is to narratively review Anatomy, Patho mechanics, and risk factors of subclinical TPD and to evaluate the clinical tests, screening tools and intervention strategies applied among high impact athletes. A detailed search of research database like PubMed, Scopus, CINAHL, Embase, SPORTDiscus, and Web of Science was conducted from January 2000 to March 2026. A PRISMA -style methodology was followed. A total of 49 articles met the inclusion criteria. The reasons reported for under recognition of this condition is multifactorial, compensatory neuromuscular adaptations, sport-specific tolerance of prodromal symptoms, and reliance on late-presenting deformity signs are the major reasons. The single-leg heel raise (SLHR) test and navicular drop test are two tests that shows stronger utility in early detection among the clinicians. Among the imaging modality Ultrasound remains in the first line. Initiating eccentric exercises early and other interventions like orthotic management ,modern biological therapies have yielded favourable outcomes for stage I condition. The reviewed research articles have used heterogenous assessment tools and clinical tests which remains as a principal limitation for this review. Validated clinical tests and functional movement assessment should be incorporated specific to the sport participation .In preseason and in-season evaluations load monitoring should be included to identify subclinical TPD.