The posterior tibial tendon runs down the back of the lower leg, connecting the posterior tibial muscle to the inside bones of the foot near the arch. This tendon helps to support the arch of the foot as well as assisting the action of the posterior tibial muscle.
This part of the foot has limited blood supply, due to the anatomy of the area, causing problems in healing conditions like posterior tibial tendonitis. Tendonitis is inflammation of a tendon, usually caused by the over-use of a joint.
The Cause of Posterior Tibial Tendonitis
- Over-use of the ankle, particularly in activities like dance, swimming, walking and running. Sports and activities that require lots of sudden changes of direction also increase the risk of posterior tibial tendonitis.
- Anatomical weakness or poor support which causes the foot and ankle to roll inwards, putting extra strain on the posterior tibial tendon.
- Trauma to the foot or ankle either by striking or sudden movement.
- Wearing poorly-fitting footwear that allows or encourages an inward rolling of the feet.
The Symptoms of Posterior Tibial Tendonitis
- Pain felt on the inside of the ankle or foot, initially after physical activity.
- Bruising or swelling on the inside of the ankle and/or the inside of the arch of the foot.
- Extending the foot upwards and standing on the toes will produce stronger pain.
- Pain will get worse if the tendonitis is not treated and will be felt at other times, especially early morning and evening.
- If left untreated, the arch will be affected. The arch will become lower and the toes will point more outwards, because the posterior tibial tendon is not capable of supporting it properly. Just putting weight on the foot will be painful.
- Rest and immobilization are necessary to allow the tendon to heal. Keeping the foot elevated will help ease pain and swelling.
- Apply ice packs every hour or two for the first few days to relieve pain and reduce swelling.
- Take anti-inflammatory medication to reduce the inflammation. Over-the-counter preparations containing ibuprofen or aspirin are easily available or a doctor can prescribe something stronger for you if necessary.
- Expect to be out of action for several weeks as tendons are notoriously slow to heal. Once the pain and swelling have diminished, you might be able to move around by wearing a splint or a brace for support. Avoid all movements which increase the pain.
- Your doctor may suggest physical therapy to help you stretch and strengthen the ankle joint again and correct any inward roll of your feet.
- When you do return to full activity, start off very gradually to avoid exacerbating the injury.
- Wearing an arch support in your shoes will protect and support the arches of your feet.
- Surgery is only considered if these treatment options are not effective.
The Prevention of Posterior Tibial Tendonitis
You want to avoid a recurrence of this condition because every time it returns, the tendon becomes weaker. These important strategies for the prevention of posterior tibial tendonitis will help you recover fully and avoid a recurrence.
It is really important to wear appropriate shoes for any activity or exercise that you do. Specialized sports shoes are made for most sports and these are the best to wear. Sports shoes have adequate cushioning for the heel, good support for the foot and ankle and arch support to protect you from posterior tibial tendonitis.
They prevent the foot from rolling inward but if this is a problem you have, you might consider custom orthotics, made specifically for your feet. Avoid wearing slippers or badly-fitting shoes, high heeled shoes or going barefoot.
Always warm-up thoroughly before any exercise. This involves raising your core temperature and stretching the tendons and muscles you are going to be using. After exercising, cool-down with stretches again to avoid muscle soreness.