Many people are aware of their larger, more superficial calf muscles, gastrocnemius and soleus. But what about the smaller, deeper and less known calf muscles? What is their purpose, and what are the symptoms when they aren’t functioning properly? Today I am writing specifically about tibialis posterior, flexor digitorum longus and flexor hallucis longus.

tibialis posterior calf massage

One of the deepest muscles of the lower leg, accessing the posterior tibialis can be the key to unlocking pain free feet, ankles and calves.

Tibialis posterior originates at the proximal, posterior shafts of the tibia and fibula (bones of lower leg) and the interosseous membrane. It inserts into all five tarsal bones (small foot bones) and bases of second through fourth metatarsals (long foot bones). It inverts the foot, plantar flexes the ankle, and helps maintain the long arch of the foot, keeping weight properly distributed to the outside of the foot.

Muscle spasm, trigger points and weakness in tibialis posterior can contribute to Achilles tendonitis, so it is wise to treat this muscle along with gastrocnemius and soleus.

Dysfunction in this muscle can give the appearance of fallen arches and can contribute to issues such as shin splints. Pain from tibialis posterior trigger points presents primarily in the Achilles tendon especially while running or walking, but can also extend to the calf, heel and sole of the foot. If you have issues with chronic heel spurs, you may explore treating this muscle, as it may be part of the problem.

Flexor digitorum longus flexes the second through fifth toes, inverts the foot, and is a weak plantar flexor of the ankle. Flexor hallucis longus performs the same actions, except that it is a flexor of the big toe instead of the other four toes. FDL originates at the posterior, mid tibia (shin bone) and inserts into the distal portion of the second though fifth toes. FHL originates at the posterior middle fibula (smaller of the two lower leg bones) and inserts into the distal phalanx of the first toe. The tendons of these two muscles, along with the tibialis posterior tendon, pass behind the medial malleolus (inside ankle bone). If you have ever taken anatomy, you may have learned the acronym Tom, Dick and Harry to help you remember which order these tendons are in as they pass behind the malleolus.

Trigger points in your long toe flexors can cause pain in the soles of your feet when walking. They can also contribute to cramps in the smaller muscles of the bottom of your feet, which can lead to hammer toe and claw toe. FDL trigger points also cause pain in the metatarsal arch and under the toes. FHL dysfunction can cause pain and numbness under the big toe, and discomfort under the first metatarsal head (large knuckle involved in bunions).

Walking or running on uneven surfaces, such as rocky ground or a sandy beach, can cause trigger points to form in any of the above muscles. Also, if you have Morton’s foot (when second MTP joint extends further out than your other MTP joints, causing instability of the foot) this can cause you to walk on the inner edges of your foot which can overwork tibialis posterior and lead to trigger points there.  Worn out shoes or any surface that causes rocking of the foot are sometimes blamed on trigger point formation of these deep calf muscles. Adjusting to wearing barefoot or minimalist style shoes, which are less stable by nature, especially when getting used to wearing them on uneven surfaces, can tire these muscles out.

Now that the weather is getting warmer and you may be doing more walking, running or hiking on uneven surfaces, educating yourself on how to treat trigger points in your deep hidden calf muscles can help! Check back for part 2 of this article for massage techniques and exercises to aid in conditioning for your spring and summer adventures.


Enjoyed this article? Read Wearing Flip-Flops is Just a Big Flop, Especially for the Flexor Digitorum Longus
Christina Summerville

Christina has been a physical therapist for over 20 years. She is a second degree black belt in Tae Kwon Do and is also a certified MELT Method® Instructor. Christina's passion is to inspire and empower her clients to rid themselves of pain and injury so they can perform at their BEST and live life to the FULLEST. She started her own small fitness and wellness business, Summerville Fitness, to help merge the worlds of healthcare and fitness, making instruction in quality movement accessible in a private wellness sessions or group classes. She loves teaching her students more about their bodies and how to help them improve posture and bring more balance to their frame. Yoga Tune Up® is her most recent certification and she is really enjoying practicing YTU and sharing it with others! Christina also incorporates Yoga Tune Up® in physical therapy sessions she provides at her PT office at Universal Chiropractic in West Seneca. She teaches at various locations in Western New York Including Universal Chiropractic in West Seneca and Live Fit in Lancaster. She is also happy to schedule customized private or group classes at your location or hers!

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Thank you so much for writing this article. It really clarified my understanding of the tibialis posterior and the toeflexors and how they can be related to a variety of pain in the calves and soles of the feet. I have had chronic issues with my right leg and the article really helped me understand how these synergistic muscles can impact the pain that I associated with my calf muscles.

jan hollander

Yes I really appreciate this article I have a lot of calf problem not so much pain but stiffness due to vacuuming on a foam mat in a bolder gym.
I will need to reread this article for all the anatomy but really benefit from it now going to read the second article

Christina Klein

This article was an great reminder to why learning how to relax certain muscles during movements is so important and how it may affect the footwear you choose, like wearing shoes that are slightly too big or flip flops. Reminds me of an client I had who had to grab the floor a lot in her house causing extreme cramps in the calf area.


I just attended an outdoor wedding that was on a grassy uneven surface. I was wearing 1 1/2 inch high heels and totally blew out my calf muscle from wearing those shoes on the uneven surface. As soon as the strained muscle heels I’ll be hitting the Roll Model balls!


This is a good read! Really helped to understand where the shin/calf muscles! I tend to ignore them, I won’t lie, but after reading this I see that there is huge value in treating AND training them more!

Kate Clark

Thank you for this article. I’m a massage therapist and a friend of mine has been complaining of foot cramping and involuntarily curling toes on one foot — I’ll see if she wants me to try checking for trigger points in the areas you suggest.


I love this post. Very often we forget about the deeper muscles, in this case of the lower leg, in favor of the more superficial muscles. It’s amazing to realize how important the Tibialis Posterior, FDL and FHL are in the actions of the foot. It reminds to think more universally in the body and that everything really is connected.


I love the contents of this article. I am a barefoot runner and walker. I started out as a flat feet person and tossing my conventional shoes away to strengthen my feet. I often walk or run on the uneven trails so I would learn to pamper my feet even more after I read this post.


This was a helpful article! It bums me out to know if we walk on bare feet outdoors that they can ware certain muscles. I thought wearing shoes were the cause of our gradual foot debilitation…The soles of our feet were created knowing we would need some sort of protection of them?? Interesting…

Erin Kintzing

This article combined with looking at drawings of these three deep calf muscles was so helpful for me to understand my calf and foot pain! I have always experienced tight calves and it is so helpful to understand the location and vocation, if you will, of the deep muscles that are often overlooked in favor of their larger counterparts. I am so looking forward to part 2 so I can learn how to target my tibialus posterior which I am sure has some trigger points (especially on my left side where my first metatarsal is much shorter than my second!).

Amanda Burchert

Thank you for the in depth info. I train for triathlon and often get cramps in my feet while swimming. I have tried changing my diet and water intake as suggested to no avail… on to part two for tips!


My gastrocnemius and soleus are always tight! This is a good reminder to pay attention to some of the other muscles that flex and extend the ankle both in a massage and strength sense. Thank you!


Thank you for such an in-depth article. I stumbled upon this as I was googling a remedy for a very tight and sore calf. Looking forward to rolling it out with the tips you provided 🙂


It’s interesting to learn that the aches and pains in my feet can be contributed to my calf muscles. Before reading this, I wouldn’t have expected how fallen arches are contributed to the tibialis posterior. While it is a smaller muscle in the calf, it affects the foot greatly. Anatomy always amazes me and how the size of a muscle doesn’t dictate its impact on the body. Even a deep muscle can have a profound effect on alignment. These kinds of learnings always fascinate me.

Kamilla Vaksman

Thank you for sharing useful information in an easy to digest way.

Regina Varos

First of thank you for this information. Now I will have to read up on Dr. Kharrazian. I have an autoimmune disease and I’m willing to try out this abdominal work to see if it helps me. I figured that I will work on my own body to what results I get. This blog gave me lots of food for thought and has given me more information to research.

Sophie Desmarais

Very interesting article and so many possible outcomes that result from not having these deeper calf muscles function properly. I am particularly fascinated on how disfunction in the tibialis posterior can lead to fallen arches. Fallen arches can create postural issues and pain at the knees, hips and low back. I see “flat” arches in most of my clients and have tried different strategies to promote arch support. I will definitely add rolling and activating the tibialis posterior in my repertoire!

Nadine Maskallis

Thank you, Christina, for this detailed article on the deeper calf muscles and how they contribute to our movement. As a runner, this anatomical lesson is tremendously helpful as is the reminder to be aware how the choice of shoe (and their condition) have an impact on these muscles.


Thank you for sharing an insightful article! I have clients that always speak of tight calves. I have a client that healed plantar fasciatis using the balls. Very informative and detailed information on what problems arise from a tight Posterior Tibialis (shin). Now, I know what specific areas to target in releasing in the area. Thank you again!


Thank you for the detailed article! I have used rolling the feet with the YTU balls all the time, and had a client heal is plantar fasciatis with the balls, but in general I hear that the stance/walking is better for the rest of the day after we meet once a week in the morning. I can see how walking on uneven grounds would aggreviate the muscles in foot and ankle. I loved the article!


Very enlightening. I do suffer from cramping in my foot and calf and get occasional shin splints (some deserved but some just appear). I’d love to see a video about how to massage this area as well.

Ariane Fournier

Je trouve ça tellement intéressant de voir la connection entre les muscles du corps! On en apprend constamment!

Linda Brown Arrandt

As a massage therapist I work with people who have feet and achilles pain often. I do deep work into the
tibialis posterior along with the gastrocnemius and surrounding muscles. This does give my clients relief.
However, now with the Yoga Tune Up Therapy balls, I can give them homework for self care. Combining this with some of the Yoga Tune up postures such as triangle, happy baby minivini, and the leg stretches they can do work on themselves prior to our sessions along the the Yoga Tune Up Therapy Balls for a greater overall release.

Suzanne Drolet

While I don’t currently have issues in these areas, I love learning about how the muscles connect and interact, and how problems can manifest in and around them. I’m intrigued by finding them and look forward to reading the next half of this post! Thanks!

Jennifer Strumfeld

I love learning about anatomy and recent issues with my feet and calves have prompted me to do more research. Thanks for so neatly summing up the deeper, less-known calf muscles and how they connect to the feet, ground and movement. I have had great success with using the therapy balls…I love to run in the mountains and using the balls daily on feet and calves has given my aging body relief and hope of longevity of sport and activity. Now that I have been educated and made aware of how to work with feet and calves, I need to… Read more »


Thanks ! this is very helpful as I love to hike

Sherri-Ann Cameron

It would be great to be able to see a video of how to massage this area out.