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Posterior Tibial Tendinopathy

(Posterior Tibial Tendonitis; Posterior Tibial Tendinosis)

Definition

Tendinopathy is an injury to the tendon. It can cause pain, swelling, and limit movement. The injuries can include:

  • Tendonitis—an inflammation of the tendon
  • Tendinosis—tiny tears in the tendon with no significant inflammation

The posterior tibial tendon runs from the posterior tibial muscle to the inside of the ankle and the arch of the foot. The main job of this tendon is to support the arch of the foot. If the tendon is injured or weak, then the arch of the foot can collapse. This will make the foot pronate, or roll inward. These injuries can make it painful to walk.

Treatment depends on the severity of the tendinopathy.

Tendonitis

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Causes    TOP

Causes of posterior tibial tendinopathy include:

  • Overuse of the tendon
  • Poor blood supply to the tendon
  • Biomechanics that cause degeneration of the tendon, such as over-pronation of the foot

Risk Factors    TOP

Posterior tibial tendinopathy is more common in women and in people over the age of 40 years. Other factors that increase your chance of posterior tibial tendinopathy include:

  • Flat feet
  • Obesity
  • Diabetes
  • High blood pressure
  • Previous surgery or trauma
  • Local steroid injections

Symptoms    TOP

Symptoms may include:

  • Pain and swelling near the arch of the foot and on the inside of the ankle
  • Pain that increases when standing on the ball of the foot or if the foot is flexed
  • Pain that increases with activity
  • Tiredness in the foot after little activity
  • Pain that becomes more disabling
  • Later in the course of the tendinopathy, a flattening of the arch of the foot and pronation
  • An inability to push off well when running

Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done. It will include a foot exam. You may be asked to try to stand on the ball of your foot. If you cannot do this you are likely to have a problem with your posterior tibial tendon.

Images of your foot and ankle may be taken. This can be done with:

Treatment    TOP

Talk to your doctor about the best treatment plan for you. Options include:

Supportive Care

The foot and ankle will need time to heal. RICE is often the main part of treatment:

  • Rest—Avoid activity that causes pain. Reduce shock or vibrations to the foot and ankle.
  • Ice—Ice therapy may help relieve swelling.
  • Compression—Compression bandages can provide gentle pressure to help move fluids out of the area.
  • Elevation—Keeping the foot elevated can help fluids drain out or prevent fluids from building up.

To help support the foot and promote healing, you may need:

  • A strap or tape for your foot
  • A brace or cast
  • Custom-made orthotics

Prescription or over-the-counter medication may be advised to reduce pain.

Physical Therapy

A physical therapist will assess your foot and ankle. An exercise program will be created to help recovery and to strengthen the muscles.

Surgery

In rare cases, surgery may be required to repair the tendon.

Prevention    TOP

To reduce your chances of posterior tibialis tendinopathy, take these steps:

  • Avoid activities and sports that repeatedly stress the foot and ankle.
  • Maintain proper muscle strength.
  • Gradually increase the frequency and intensity of exercise.
  • Wear good, supportive shoes that provide arch support.
  • Use proper technique for sports and dance activities.

RESOURCES:

The American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org
OrthoInfo—American Academy of Orthopaedic Surgeons
http://www.orthoinfo.org

CANADIAN RESOURCES:

Canadian Orthopaedic Association
http://www.coa-aco.org
Canadian Orthopaedic Foundation
http://www.canorth.org

References:

Gluck GS, et al. Tendon disorders of the foot and ankle, part 3: the posterior tibial tendon. Am J Sports Med. 2010;38(10):2133-2144.
Houck J, Neville C, Tome J, Flemister A. Randomized controlled trial comparing orthosis augmented by either stretching or stretching and strengthening for stage II tibialis posterior tendon dysfunction. Foot Ankle Int. 2015;36(9):1006-16.
Mazieres B, et al. Topical ketoprofen patch in the treatment of tendinitis: a randomized, double blind, placebo controlled study. J Rheumatol. 2005;32(8):1563-1570.
Posterior tibial tendon dysfunction. American Academy of Orthopaedic Surgeons Ortho Info website. Available at:
...(Click grey area to select URL)
Updated December 2011. Accessed March 11. 2016.
Posterior tibialis tendon dysfunction. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated June 7, 2016. Accessed September 23, 2016.
Tibialis posterior tendinosis and tibialis posterior tenosynovitis. Merck Manual for Health Care Professionals website. Available at:
...(Click grey area to select URL)
Accessed March 11, 2016.
Last reviewed March 2017 by EBSCO Medical Review Board Laura Lei-Rivera, PT, DPT, GCS
Last Updated: 4/29/2014

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