Posterior Tibial Tendonitis

The Tibialis Posterior muscle is one of the muscles that forms your calf. It sits behind the tibia bone, and it's tendon runs from the inside lower 1/3 of your calf around your inside ankle bone (medial malleolus) and attaches to your navicular bone on the inside of your foot. The main job of your Tibialis Posterior muscle is to support your arch and to invert your foot. Unfortunately, due to the work load that is required of this muscle and it's tendon, it can become fatigued and damaged which can lead to pain, primarily around your inner ankle area.

Tibialis Posterior Tendinitis, sometime called Tendinosis, is nearly always caused by an overloading or overuse of the tendon. This overuse can be caused by exercises that will overload the muscle, for example loaded calf raises, or overtraining - for example suddenly increasing your exercise regime or starting a completely new regime.

There is never exactly one reason why you will have Tibialis Posterior Tendonitis. The factors that will contribute to this problem are listed below;

  1. Foot Posture - A low arched foot, or flat foot will create an environment to overload your Tibialis Posterior muscle. As your Tibialis Posterior works to support your arch and invert your foot, if your foot naturally is more collapsed or "pronated", this will increase the work on your muscle.
  2. Weak Muscles - Ankle joint stiffness whether it is caused by joint restriction or calf muscle tightness can create extra work for the Tibialis Posterior muscle.
  3. Increased Activity - Simply, if you increase your activity level suddenly, you will overload and potentially damage your Tibialis Posterior tendon.
  4. Hormonal Changes - Post menopausal women are at an increased risk for Tibialis Posterior Tendonitis and other tendon problems. The current hypothesis for the reason for this is due to a change in the make up of the tendon itself, leading to an increased risk of damage.
  5. Diabetes - As with menopause, diabetes can change the make up of the tendon and therefore make you more prone to tendon damage.

Symptoms

  • Pain or tenderness which occurs on the inside of your lower leg, ankle or foot. The pain is often worse with weight-bearing activity, and standing for long periods is also often painful.
  • Swelling can be sometimes be seen along the course of the tendon.
  • Over time, the arch along the length of the inside foot will gradually collapse, the foot appears to become flat and your shoes may feel like they are too small. This is known as an "acquired flat foot."
  • You will be unable to raise their heel and go onto their tiptoes on the affected side.

Treatment Options

Treatment will vary depending on the severity and the duration of your condition, but may include;

  1. Anti-inflammatory medicines can reduce pain and inflammation
  2. An offloading boot "moon boot" is sometimes needed to rest the tendon.
  3. Changing and improving your footwear can also reduce pressure on the tendon.
  4. Orthotics to improve the foot position and reduce strain on the tendon may be required
  5. Exercises to strengthen the Tibialis Posterior muscle will also be prescribed
  6. Rest, Ice, Compression and Elevation

WARNING! If left untreated, this injury can lead to damage that can be very difficult to reverse. It is imperative that you seek treatment if you have noticed pain in your medial ankle area, or if your foot has been gradually flattening over time. Sometimes, conservative management may not be able to help your Tibialis Posterior pain, at this point we may need to refer you for surgical consultation.

If you have any concerns about your ankle pain, drop us a line. Treatment for this problem can improve your quality of life and the ability to do the activities you love.

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