Dr. Bartholomew discusses the symptoms and treatment options for posterior tibial tendonitis.
The anatomy of your feet and ankles breaks down like this: You have 26 bones, 33 joints, and over 100 muscles, ligaments and tendons in each foot. These tissues all work in harmony when everything is going well, but sometimes problems disrupt the natural flow. Some of these problems can just be a nuisance but there are a few that can be a nightmare.
One such problem is posterior tendonitis, but our office can provide care to ease your pain, recover
from injury, and get back to your daily activities.
You rely on your ankles for more activities than you probably realize. At least, you might not realize it when your ankles are healthy. If you are suffering from ankle pain, it can be easy to see how much you use these valuable joints for everything from walking and running, to driving your care and even simply standing.
If there is pain on the inside of the ankle that extends to the arch, this could be a case of posterior tibial tendonitis. Let’s take a closer look at this tendon, how it affects you, and what we can do about it for you.
It is difficult to overstate the importance of your ankle joints, but easy to take for granted the way they are intricately structures to perform well. To start with, there are actually two separate joints that are often collectively known as the “ankle joint.” The “true ankle joint” is located where the 2 leg bones (tibia and fibula) meet the talus (ankle bone). The other joint is underneath the talus that sits on top of the calcaneus (heel bone). These two bones form the “subtalar joint.”
The true ankle joint enables the foot to move up and down, whereas the subtalar allows for side-to-side movement.
The respective joints are supported and held together with ligaments that connect the bones together, and tendons – including the posterior tibial tendon – that connect muscles to bones. It starts in the lower leg next to the calf muscle, goes down the leg to the inside of your arch, and stabilizes the foot. It limits too much pronation and prevents the foot from collapsing. Pronation is the natural inward rolling motion performed by your foot with every step you take that acts like a shock or strut in a car. This tendon will become stretched and torn if it has to do more work that it is intended to do.
Tendonitis is a term we use for a tendon that has become inflamed, often from overuse (too much unprotected activity or too great of body mass). The posterior tibial tendon’s job is to slow down and stop 2x of your weight at the end of EVERY step.
Symptoms
Symptoms can include pain, especially along the inside of the ankle and at the arch over the Navicular bone. Symptoms get worse with activity. In chronic cases, pain may develop on the lateral/outside joints of the ankle.
When the heel bone shifts or tilts towards the outside, it is typically the result of a collapsed arch (posterior tibial tendon dysfunction). The posterior tibial tendon plays a vital role in supporting the foot arch. When the tissue becomes elongated or stretched, it loses its ability to properly hold up the arch.
Signs that we will look for when diagnosing this condition include: a collapsed arch, the heel tilting outward, pain and swelling on the inside of the foot and ankle (where the posterior tibial tendon is located), looking at the foot from behind and seeing “too many toes,” and weakness and pain when a patient raises the heel up while standing on one foot.
Although diagnostic imaging tests that can be used to confirm the condition, x-rays, MRI, CT scans, and ultrasound, this is generally a clinical call. These types of tests are useful in determining the extent of tearing and joint damage if surgery is required.
Treatment Options
The good news with this injury, surgery is rarely necessary. We can usually find success with the use of nonsurgical treatment options like:
Protection – stopping the offending biomechanics with splints and strappings is a priority in the treatment plant. I do not like stopping activity but expect to modify or reduce weight bearing activity.
Ice – Using cold therapy on the painful areas of the posterior tibial tendon will keep swelling down. Ice or cold packs wrapped in a thin towel and applied 3 or 4 times a day for around 20 minutes will help. Frozen bags of veggies are easy to use – just use veggies you don’t like!
NSAIDS – Nonsteroidal anti-inflammatory medication can reduce pain and inflammation. These are not treating the cause, but rather mask the symptoms. Consult with your doctor before taking ibuprofen, naproxen, or any other pain relievers.
Immobilization – This is at last resort. With chronic or extensive tendon damage we may need to immobilize the area with the use of a cast or walking boot.
Orthotics and Braces – Once I control the tendon damage and comfort returns, orthotic devices are useful for controlling the mechanics of your foot. A brace can support the joints of your foot to take tension away from the tendon. The brace gets larger the more damage that has occurred.
Key points with posterior tibial tendonitis: this is smoldering problem so the earlier it is addressed, the better long-term outcomes. Just like a fire, the longer it is around, the more damage to soft tissue and cartilage occurs.
The mechanics is most likely the cause and until this is addressed, expect reoccurring problems.
Pain and weakness with a single leg heel raise is a major red flag.
When conservative methods do not achieve the desired results, it may be time to consider surgical procedures to fix the condition.
Experiencing pain from posterior tendonitis? Contact Dr. Bartholomew’s office at (239) 430-3668 (FOOT) or visit www.NaplesPodiatrist.com to schedule an examination.
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