Posterior Tibial Tendinopathy

Did You Know?

This tendon has a very important role in stabilising the ankle.

What Is Posterior Tibial Tendinopathy?

Posterior tibial tendinopathy is a common but often overlooked condition that affects the tibialis posterior tendon, which connects tibialis posterior (muscle) to the inside of the foot. This tendinopathy, if left untreated, can cause chronic pain and instability in the ankle and foot.

Anatomy

The posterior tibial tendon is a vital structure that supports the arch of the foot. The muscle (tibialis posterior) sits within the calf complex very close to the inside of the tibia and inserts onto the inside of the foot on the bones above the arch (navicular/cuneiform. This tendon is responsible for creating stability within the foot as it progresses into propulsion during walking, running, and jumping.

In individuals with posterior tibial tendinopathy, the tendon undergoes degeneration due to repetitive stress, which results in ankle pain, weakness, and inflammation. If left untreated, the condition can lead to the collapse of the arch, which can cause significant discomfort and make walking difficult.

It is important to understand the anatomy of the posterior tibial tendon to better appreciate how it functions and the importance of treating this condition promptly. If you experience any pain or discomfort in the ankle area, it is crucial to consult with a medical professional for proper diagnosis and treatment. With proper care and management, individuals with posterior tibial tendinopathy can recover fully and prevent the condition from recurring.

Symptoms

The symptoms of posterior tibial tendinopathy can vary depending on the severity of the condition. In the early stages, individuals may experience pain and swelling on the inner side of the ankle. This pain is often worse with activity, especially activities that involve standing, walking, or running. As the condition progresses, the pain may become more persistent and may radiate along the inner arch of the foot.

In addition to pain, individuals with posterior tibial tendinopathy may notice a flattening of the arch of the foot. This is because the posterior tibial tendon plays a crucial role in supporting the arch and when it becomes inflamed or damaged, the arch may collapse. This can lead to difficulty walking or standing for long periods of time.

It is also common for individuals with posterior tibial tendinopathy to experience weakness in the affected ankle and foot. This can make it challenging to perform activities that require balance or forceful movements, such as climbing stairs or participating in sports.

What Causes Posterior Tibial Tendonitis?

Posterior Tibial Tendinopathy can develop from a variety of causes. The posterior tibial tendon, responsible for supporting the arch of the foot and stabilizing the ankle, can become overworked, leading to inflammation, degeneration, and eventual damage.
The most common causes of Posterior Tibial Tendinopathy include:

Overuse – a sudden increase in activity can lead to an increased risk of damaging this tendon

High impact activity – activities like running and jumping can lead to an increased risk.

Foot function – certain foot types such as very flexible feet that have a tendency to pronate heavily can lead to increase loading of this tendon

Footwear – certain shoes that are unsupportive and very soft and flexible can lead to an increased risk of tendinopathy

Age – wear and tear over a long period can lead to stress and damage within this tendon

How To Treat Posterior Tibial Tendinopathy

Like with most injuries that are many factors to consider when treating Achilles tendinopathy. My initial advice would be to book in one of our MSK podiatrists so that they can accurately diagnose and treat the condition. Common treatments include

Orthotic Therapy
Orthoses can be designed to reduce load on the tendon when you are walking or exercising. This treatment is often used in combination with a strength and rehabilitation programme.

Strength & Rehabilitation
Strengthening the gastrocnemius and soleus muscles are often utilised when treating Achilles tendonitis. Eccentric and isometric exercises are often integrated within the programme as evidence suggests it is very effective when treating this condition.

Shockwave Therapy
Shockwave therapy can be used to stimulate recovery when dealing with this condition. This is often utilised when the condition has reached a chronic state (approx. 4 months).

Other treatments can include:

Steroid Injections
In my opinion due to this being an invasive procedure you should only consider steroid injections as a last option.