As a podiatrist, I frequently treat patients struggling with posterior tibial tendonitis - inflammation of the tendon supporting the inner arch. This overuse injury causes inside ankle pain, arch collapse, and progressive flatfoot deformity if not promptly addressed.
Understanding the anatomy and biomechanics related to posterior tibial issues allows me to provide effective, multi-faceted treatment restoring function and preventing long-term joint damage. Here’s an in-depth guide on causes, symptoms, and evidence-based care for this common concern.
Anatomy and Function of the Posterior Tibial Tendon
The posterior tibial tendon originates in the calf muscles, courses down behind the inner ankle, and attaches along the inner arch’s bony prominences. Acting like a dynamic suspension bridge cable, it maintain the arch’s structural integrity.
It plays a crucial role supporting our body weight during standing, walking, running - especially in push-off. Unfortunately, this tendon endures substantial repetitive loads making it prone to painful inflammation.
How Posterior Tibial Tendonitis Develops
While acute injuries can occur, posterior tibial tendonitis more often emerges gradually from cumulative minor strain. Contributing factors include:
Overuse
High volume athletic training lacking rest periods
Intrinsic foot structure
Rigid, flatfoot alignment increases strain on the tendon
Trauma
Ankle sprains/fractures alter adjacent soft tissue forces
Age
Declining circulation and elasticity with aging
Obesity
Excess weight overloads the tendon
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Diabetes
Nerve damage and impaired blood supply slows healing
Inflammatory diseases
Associated conditions like rheumatoid arthritis or lupus
Eventually microscopic tears cause persistent swelling and irritation inside the ankle. Early diagnosis and care helps avoid progression to larger tears or rupture.
Recognizing Posterior Tibial Tendonitis Signs
Many patients first notice pain along the inner ankle with a recent uptick in athletic activity. Additional hallmark symptoms include:
Swelling and warmth along the tendon’s path
Tenderness when squeezed behind the ankle
Pain when standing on tiptoes
Difficulty lifting the arch properly when walking
Eventual arch flattening resulting in a slapping gait
Foot rolling inwards excessively (overpronation)
I also assess risk factors like age, weight, and medical history when evaluating patients. X-rays, ultrasounds, or MRI scans help gauge structural damage guiding appropriate treatments.
Evidence-Based Posterior Tibial Tendonitis Treatments
Initially, therapy focuses on alleviating irritation allowing the tendon to rest and heal. I tailor combinations of:
Immobilization boot
Limits ankle motion to calm inflammation
Physical therapy
Stretches calf muscles and stimulates healing
Orthotics
Supports arch reducing strain on tendon
Anti-inflammatories
Oral medication combined with topical gels
Bracing
Limits excess foot flattening motion
Injections
Platelet-rich plasma or steroid injections reduce swelling
Patients require 4-6 months rest from aggravating activity for optimal recovery. I then advise gradually transitioning back based on ongoing symptoms and functional gains.
Posterior Tibial Tendonitis Self-Care
For long-term relief, I provide tailored home care regimens focused on:
Rest periods
Taking days off from intense lower limb exercise
Ice massage
Applying ice directly to the tendon in 10 minute intervals
Contrast baths
Alternating hot and cold water immersion
Calf stretching
Easing tight muscles reducing strain on the tendon
Foot strengthening
Intrinsic exercises enhance arch stability offloading the tendon
Arch support
Over-the-counter orthotics or arch taping between appointments
Proper footwear
Shoes with cushioning and stability minimizing irritation
Educating patients empowers them to take an active role minimizing recurrence between podiatry visits. I monitor their home exercise compliance and evolving symptoms to make appropriate care adjustments.
When to See a Podiatrist for Posterior Tibial Issues
See a podiatrist promptly if you experience:
Ongoing stiffness, swelling, and inside ankle pain
Inability to complete heel raises due to discomfort
Progressively collapsing arches or flatfoot deformity
Limping gait from arch instability
Worsening pain despite rest and over-the-counter anti-inflammatories
While partial tears may heal with conservative care, delays seeking treatment risks total rupture. This permanently compromises the tendon’s ability to dynamically support the arch - requiring surgery. Early intervention optimizes outcomes.
Skilled Podiatric Care Keeps You Active
The posterior tibial tendon bears considerable load during daily walking and athletic endeavors. With time, this indispensable connective tissue suffers cumulative damage from sheer repetitive use.
Combining smart training habits and rapid podiatric treatment at the earliest signs of pain allows maintaining an active lifestyle long-term. My comprehensive understanding of lower limb biomechanics informs personalized rehabilitation programs and prevention strategies.
If nagging ankle discomfort or collapsing arches start interfering with your quality of life, make an appointment to get evidence-based care keeping you on your feet pain-free. With multi-modal therapies, you can confidently stay active relying on your feet again.
Key Takeaways
Posterior tibial tendonitis causes inside ankle pain from arch support tendon inflammation
Recognize early signs like swelling, arch flattening to optimize treatment
Podiatrists offer bracing, injections, and physical therapy for pain relief
Self-care like stretching, ice, and orthotics aid recovery between appointments
Don’t delay with worsening ankle symptoms which risks tendon rupture
Combining treatments and training adjustments allows continuing active lifestyles
FAQs
What causes posterior tibial tendonitis?
Frequent overloading with running, jumping activities strains the tendon over time. Intrinsic flat or rigid foot alignment also increases risk. Other factors include age over 40 years old, obesity, and inflammatory diseases.
How do you differentiate posterior tibial tendonitis from Achilles tendonitis?
Location differentiates the two. Posterior tibial involves the inner ankle, while Achilles affects the back outer ankle. Activities aggravating symptoms also differ based on specific tendon function.
When should surgery be considered for posterior tibial issues?
Surgery may be indicated after 6-12 months of dedicated conservative therapy in patients with severe, non-healing tendon damage, or in cases of total rupture where the tendon can’t be repaired nonsurgically.
Can custom orthotics help posterior tibial tendonitis if I don't have arch support shoes?
Yes, custom orthotics work as part of a multifaceted treatment plan by supporting the arch and offloading strain on the injured tendon. Wear orthotics in all shoes until pain and function improves.
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