Posterior Tibial Tendonitis. What is it and how to treat it.

Posterior Tibial Tendonitis. What is it and how to treat it.

Your feet and legs contain a lot of tendons, and the posterior tibial tendon is one of the most important. A tendon attaches muscles to bones, and the posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot. The main function of the tendon is to hold up the arch and support the foot when walking.


What you need to know about posterior tibial tendonitis

Posterior tibial tendonitis is the inflammation of the posterior tibial tendon. In general, the prevalence of tibial tendionitis is higher in women and the risk increases once you’re over 40 years old. Other significant risk factors are hypertension, obesity and diabetes.

Symptoms of posterior tibial tendonitis include redness, swelling or pain on the inner arch, heel or ankle and foot pain that increases during activities that put stress on your feet; like running or jumping. When you are suffering from these symptoms or think you have posterior tibial tendonitis, you should see a medical professional for an examination, a diagnosis and a treatment plan.

Untreated posterior tibial tendonitis may damage the tendon progressively and may result in collapsed foot arches or into flat-footedness that requires corrective surgery.


Possible symptoms

  • Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area.
  • Increasing foot pain during high-intensity or high-impact activities. Some patients can even have trouble walking or standing for a long time.
  • Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot.


At the root of tibial tendonitis

The American Academy of Orthopaedic Surgeons (AAOS) listed a number of possible causes and risk factors which are mostly related to overuse and (other) injuries that affect the position of the foot: 

  • Acute injuries like a tendon sprain or tear is a common injury that can lead to post tibial tendonitis.
  • Overuse. Participating in sports that require a lot of jumping, running, or repetitive impacts to the foot can increase risk.


Treatment options

Tibial tendonitis can be very persistent, from alleviating the symptoms to healing the symptoms, 6 to 9 months or even longer are no exception. Immobilizing the foot as much as possible is key in the rehab process. 

The AAOS sees the following non-surgical treatments for posterior tibial tendon dysfunction:

  • Rest: Decreasing or even stopping activities that worsen the pain is the first step. Switching to low-impact exercise is helpful. Biking, elliptical machines, or swimming do not put a large impact load on the foot, and are generally tolerated by most patients.
  • Ice: Apply cold packs on the most painful area of the posterior tibial tendon for 20 minutes at a time, 3 or 4 times a day to keep down swelling. Do not apply ice directly to the skin. Placing ice over the tendon immediately after completing an exercise helps to decrease the inflammation around the tendon.
  • Physical therapy that strengthens the tendon can help patients with mild to moderate disease of the posterior tibial tendon.
  • Most people can be helped with orthotics and braces. An orthotic is a shoe insert which is the most common non-surgical treatment for a flatfoot. An over-the-counter orthotic may be enough for patients with a mild change in the shape of the foot. A custom orthotic is required for patients who have moderate to severe changes in the shape of the foot. A custom orthotic is more costly, but it allows the medical professional to better control the position of the foot.
  • Nonsteroidal Anti-inflammatory Medication: Medication, such as ibuprofen or naproxen, reduce pain and inflammation. Taking such medications half an hour before exercise helps to limit inflammation around the tendon. The thickening of the tendon that is present is a degenerated tendon will not go away with medication. Talk with your primary care doctor if the medication is used for more than 1 month.
  • Cortisone injections: Cortisone is a very powerful anti-inflammatory medicine that your doctor may consider injecting around the tendon. A cortisone injection into the posterior tibial tendon is not normally done. It carries a risk of tendon rupture. Discuss this risk with your doctor before getting an injection.


How good insoles can help

Early intervention of posterior tibial tendonitis is key to reduce damage to your foot and ankle. Orthotics are often recommended as a nonsurgical treatment. They provide support, correct biomechanical irregularities in your foot, and limit the progression of your foot’s malfunction.