Definition

Tendinopathy is an injury to the tendon. It can cause pain, swelling, and limit movement. The injuries can include:

  • Tendinitis—an inflammation of the tendon. (Although this term is used often, most cases of tendinopathy are not associated with significant inflammation.)
  • Tendinosis—microtears (tiny breaks) in the tendon tissue with no significant inflammation.
The posterior tibial tendon runs from the posterior tibial muscle to the inside of the ankle and the arch of the foot. The main job of this tendon is to support the arch of the foot. If the tendon is injured or weak the arch of the foot can collapse. This will make the foot pronate (roll outward). These injuries can make it painful to walk.

Tendinitis

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Causes

The tendinopathy is caused by overuse of the posterior tibialis tendon. This most often occurs due to:

  • Running and jumping
  • Dancing, for example ballet pointe work and excessive foot rotation
  • Trauma with high impact

Risk Factors

Factors that increase your chance of posterior tibial tendinopathy include:

  • Chronic inflammation—history of rheumatoid arthritis or other arthritic conditions
  • Obesity
  • Diabetes
  • Hypertension—high blood pressure
  • Previous surgery or trauma
  • Local steroid injections
  • Having pronated feet (rolled outward)
  • Aging—tendons may become weaker with age

Symptoms

Symptoms may include:

  • Pain and swelling near the arch of the foot and on the inside of the ankle
  • Pain that increases when standing on the ball of the foot or if the foot is flexed
  • Pain that increases with activity
  • Tiredness in the foot after little activity
  • Pain that becomes more disabling
  • Later in the course of the tendinopathy, a flattening of the arch of the foot and pronation
  • An inability to push off well when running

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done, paying special attention to the foot. Pain in the ankle and foot can be due to many causes. Posterior tibialis tendinopathy can be difficult to diagnose.

The doctor will try to feel the tendon through your skin. He/she will note how the foot moves and handles resistance to moving the foot inwards. The doctor will look at the foot from behind and from the side and see how flat the arch is. You may be asked to try to stand on the ball of your foot. If you cannot do this you are likely to have a problem with your posterior tibial tendon.

To confirm changes in your foot and exclude other causes, your doctor may order:

  • X-rays —a test that uses radiation to take a picture of structures inside the body
  • MRI scan —a test that uses magnetic waves to make pictures of the inside of the body

Treatment

The goals of treatment are to:

  • Prevent the foot from pronating
  • Decrease inflammation and prevent deterioration of the tendon

You may be referred to an orthopedic specialist. Early treatment and correction of the underlying cause improves the prognosis. Treatment may include:

  • RICE—rest, ice, compression and elevation
  • Strapping or taping the foot; some people need a cast or a brace
  • Physical therapy, including:
    • Exercises to strengthen the posterior tibial muscle
    • Correction of poor dance or exercise techniques
  • Custom-made orthotics—These are shoe inserts that can decrease tension on the tendon, reduce pronation, and help support the foot.
  • Surgery to repair the tendon

Prevention

To help prevent posterior tibialis tendinopathy, practice good foot care:

  • If you notice you are walking on the inner aspect of your foot, consult a doctor. Early care leads to better prognosis.
  • If you have a foot or ankle injury, get medical care.
  • Wear good, supportive shoes that provide arch support.
  • Obtain proper training for sports and dance activities.