Posterior Tibial Tendinopathy
(Posterior Tibial Tendinitis; Posterior Tibial Tendinosis)
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 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
Factors that increase your chance of posterior tibial tendinopathy include:
- Chronic inflammation—history of rheumatoid arthritis]]> or other arthritic conditions
- Hypertension—high blood pressure
- Previous surgery or trauma
- Local steroid injections
- Having pronated feet (rolled outward)
- Aging—tendons may become weaker with age
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
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:
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
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.
American Academy of Family Physicians
American Academy of Physical Medicine and Rehabilitation
American Orthopaedic Foot and Ankle Society
Canadian Orthopaedic Association
Canadian Orthopaedic Foundation
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Posterior tibialis tendinopathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 2008. Accessed May 11, 2009.
Emergency Medicine: Concepts and Clinical Practice. 6th ed. Mosby-Year Book, Inc.; 2006.
Emergency Medicine: Concepts and Clinical Practice. 4th ed. Mosby-Year Book, Inc.; 1998.
Kelley's Textbook of Rheumatology. 7th ed. WB Saunders Co.; 2005.
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Pediatric and adolescent sports injuries. Clinics in Sports Medicine. 2000.
Textbook of Primary Care Medicine . 3rd ed. Mosby Inc; 2001.
Last reviewed November 2008 by ]]>John C. Keel, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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