The tibialis posterior tendon revisited: a classification-based anatomical and radiological framework

The tibialis posterior tendon (TPT) demonstrates substantial anatomical variability in its branching and attachment morphology, extending beyond the simplified concept of a predominantly navicular attachment. This narrative review critically reappraises the classification of TPT attachment patterns proposed by Olewnik and places it in the context of subsequent anatomical, radiological, and functional evidence. Later anatomical studies have confirmed extensive variation in the number, distribution, and surface area of TPT attachments and have identified configurations not represented within the original classification. These findings support the use of classification systems as structured descriptive frameworks rather than exhaustive catalogues of TPT morphology. Cadaveric imaging studies demonstrate that complex TPT branching and attachment anatomy can be depicted on MRI; however, individual anatomical types and subtypes have not undergone systematic radiological validation. Representative MRI examples are therefore included for anatomical illustration rather than as diagnostic criteria. The functional significance of individual attachment patterns and their potential relationship to hindfoot and midfoot joint morphology remain incompletely understood. Further anatomical, imaging, and biomechanical studies are required to determine whether specific TPT patterns have reproducible radiological or functional correlates.