The posterior tibialis tendon is located along the inner side of the ankle, running into the foot. It connects the posterior tibial muscle (located at the back of the shin bone) to the foot. Problems with this tendon typically occur underneath the prominence of the medial malleolus (inner ankle bone) because this area is prone to having a compromised or decreased blood supply. Decreased blood supply makes this tendon prone to injury and overuse injuries are common. Healing time is also greater because of circulation issues. The posterior tibialis muscle helps support the medial arch of the foot. Tendinitis or dysfunction of this muscle may result in a drop in the arch of the foot.

Posterior tibialis tendinitis is most often caused by an overuse repetitive strain injury (RSI). Other high risk activities or conditions that can lead to the development of posterior tibialis tendinitis include:

  • Participating in athletic activities that can strain the ankle and foot, like soccer or running.
  • Repetitive strain injuries (RSI) at work occur in people who have jobs that require performing activities of a repetitive or forceful nature, like walking up and down stairs.
  • Sudden trauma or an accident, like a fall where an individual lands hard on their ankle.
  • Patients with rheumatoid or osteoarthritis may be susceptible to posterior tibialis tendinitis.
  • Pain or tenderness along the inside of the foot and ankle (over the posterior tibialis tendon) that can radiate to the foot or lower leg.
  • Pain or burning sensation during activities
  • Difficulty performing activities of daily living
  • Weakness may occur as the inflammation gets worse
  • Feeling of tightness or loss of motion due to discomfort
  • Swelling of the tendon
  • Loss of motion at the ankle

If an individual suspects they have posterior tibialis tendinitis, the initial treatment should consist of avoiding the positions and activities that produce the pain. A course of conservative treatment is usually recommended that would include rest and immobilization, possible splinting, ice, physical therapy and non-steroidal medications to reduce inflammation.

If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy. In severe cases surgical intervention may be needed to correct any mechanical causes of the tendon irritation.

Procedures that your physician may recommend and perform in addition to physical therapy may include:

  • REST and ICE
  • The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
  • Steroidal injections to reduce inflammation
  • Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
  • Surgery to correct underlying pathology or the cause of the posterior tibialis tendinitis
  • Splinting to rest or immobilize the ankle and effected tendons

Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of posterior tibialis tendinitis include:

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage, manual stretching and joint mobilization by a physical therapist to regain mobility and range of motion of the ankle and tendon.
  • Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the ankle and effected muscle.
  • Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity, and improve movement technique and mechanics (for example, running, jumping, kicking, or stepping) in daily use of the involved lower extremity.
  • Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the ankle and tendon.
  • Home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.

Prognosis

Most people recover full function following a course of conservative care that includes physical therapy, medication and/or injections. It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities. Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of posterior tibialis tendinitis.

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