Posterior Tibial Tendonitis
He runs a biomechanical assessment clinic, advises on footwear and custom orthotics.
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Understanding the Posterior Tibial Tendon and Its Role in Your Foot
The Posterior Tibial Tendon plays a critical role in keeping your foot stable. It runs along the inner side of your ankle and connects a muscle in your lower leg (the Posterior Tibialis) to the bones in your foot, particularly the navicular bone. This tendon helps support your arch and allows you to turn your foot inward and point your toes downward.
When the tendon is overworked or strained, it can become irritated, leading to pain and discomfort. This condition is known as Posterior Tibial Tendonitis.
What Causes Pain in the Posterior Tibial Tendon?
There are many reasons why this tendon can become inflamed. The most common cause is a sudden increase in activity, such as walking more steps than usual or increasing your running distance. Sudden running speed, volume, or intensity changes are common triggers, especially if you’ve been training for events like marathons.
An ankle injury, like a sprain or fracture, can sometimes lead to compensatory movements that put extra strain on the tendon. If you have flat feet or your arch collapses, this can also overstretch the tendon and lead to inflammation. While it’s less common, those with a stiff big toe or a high arch can also experience this condition, especially if their feet struggle to push off properly.
Another contributing factor could be the type of shoes you wear. Although sandals like Birkenstocks are more supportive than other footwear, they may not provide enough support compared to a good pair of running shoes. Being overweight can also increase pressure on the tendon, leading to pain.
Recognising the Symptoms of Posterior Tibial Tendonitis
People with Posterior Tibial Tendonitis typically experience pain on the inner side of their ankle, sometimes extending down into the foot’s arch. Swelling may be present in more acute cases, though bruising is uncommon unless there’s a tendon tear.
You might notice the pain is worse first thing in the morning, especially when you step out of bed. This discomfort tends to ease up after about an hour. Pain usually increases with activity and decreases with rest. If the tendon is aggravated throughout the day, it may also be sore by bedtime. However, it’s rare for this condition to wake you up during the night.
In severe cases, walking can become painful, and you might hear or feel a clicking or crunching sensation in your ankle. Over time, the pain can shift from a sharp to a dull ache, especially in chronic cases. Without proper treatment, some people may even experience a collapse of their arch, which can eventually lead to flatfoot.
How Can Posterior Tibial Tendonitis Be Diagnosed?
Your Physiotherapist typically starts with a physical examination, feeling along the tendon for pain or tenderness. They may ask you to move your foot in specific ways to see if the tendon is irritated. If there is pain when turning your foot inward or pointing your toes down, it may indicate tendonitis.
In some cases, an ultrasound or MRI scan may be recommended to confirm the diagnosis, especially if the symptoms are severe. These imaging tests provide a detailed view of the tendon, helping rule out other conditions, such as a tendon tear or issues with the Flexor Hallucis Longus tendon, often confused with Posterior Tibial Tendonitis.
Managing Your Symptoms at Home
If you suspect that you have Posterior Tibial Tendonitis, you can manage the condition at home by resting and avoiding high-impact activities like running or jumping. You can also try applying ice to the painful area to reduce inflammation and pain.
Wearing supportive shoes or an ankle brace can help stabilise the tendon and reduce the strain. Avoid standing or walking for extended periods.
Professional Treatment Options
Physical therapy is the most effective treatment for more persistent cases of Posterior Tibial Tendonitis. Therapists may use taping techniques to reduce the load on the tendon and ease pain, or they may recommend using a brace for short-term support. These measures help to protect the tendon while it heals.
Activity modification is often necessary. For runners, this may mean reducing running volume or switching to lower-impact activities like cycling or swimming. Strengthening exercises are also crucial. These typically start with band exercises and gradually progress to more challenging weight-bearing activities.
Sometimes, your healthcare provider may suggest a gait analysis to assess how your walking or running pattern affects the tendon. Insoles or orthotics can be prescribed if needed to provide better foot alignment and long-term relief.
For very painful cases that don’t respond to therapy, a steroid injection may offer temporary pain relief. However, this is generally avoided due to the potential long-term weakening of the tendon.
How Long Does It Take to Recover?
Recovery time depends on the severity of the condition. In mild cases, with proper care and physical therapy, most people feel better within 6 weeks. For more chronic cases, it may take up to 12 weeks to fully recover, especially if there is tendon dysfunction or collapse of the arch. Following a structured treatment plan with a physical therapist is key to speeding up recovery and preventing future issues.
Expert Advice from Flawless Physio
Written by James McCormack, a lower limb specialist with extensive experience in treating foot conditions. If you’re dealing with any of the issues mentioned in this article, seeking advice from a qualified healthcare professional is important. James is available for both virtual consultations and face-to-face appointments in his London clinic.