Understanding Posterior Tibial Tendonitis

Posterior tibial tendonitis is a common yet often overlooked condition that affects one of the most vital tendons in the foot. This tendon plays a crucial role in supporting the arch and enabling normal foot function during walking. In this detailed guide, we will explore what causes this condition, how to recognise its symptoms, and the most effective treatment options available through the lens of a podiatrist like Manly Cove Podiatry.

What is Posterior Tibial Tendonitis?

Posterior tibial tendonitis is an inflammation or overstretching of the posterior tibial tendon, which connects the calf muscle to the bones on the inside of the foot. This tendon is fundamental in holding up the arch and providing stability when you walk.

Function of the Tendon: It assists in walking by controlling the inward movement of the foot and supporting the arch.
Impact of Injury: Damage to this tendon can lead to pain, swelling, and progressive flattening of the foot if left untreated.
Common Among: It often affects adults who engage in high-impact sports, have a history of overuse, or possess certain foot structures prone to stress.

Causes of Posterior Tibial Tendonitis

Understanding the causes of posterior tibial tendonitis is essential for prevention and effective management. The condition typically arises from a combination of overuse and susceptibility due to anatomical factors.

Overuse and Strain: Repetitive activities that put stress on the tendon, such as running, walking, or climbing, can lead to inflammation.
Biomechanical Issues: People with flat feet or an abnormal gait are at higher risk as their tendon works harder to maintain arch stability.
Injury and Trauma: Direct injury to the tendon, such as from a fall or accident, can initiate tendonitis.
Age and Health Factors: As we age, the tendon loses elasticity and is more susceptible to injury. Obesity and diabetes can also contribute to its degeneration.

Recognising the Symptoms of Posterior Tibial Tendonitis

Early recognition of the symptoms of posterior tibial tendonitis is crucial for preventing further damage and ensuring effective treatment.

Pain Along the Tendon: Pain typically occurs on the inside of the foot and ankle, which may worsen with activity and improve with rest.
Swelling and Tenderness: Swelling along the course of the tendon, especially after prolonged standing or physical activity.
Changes in Foot Shape: As the condition progresses, there may be observable flattening of the arch of the foot.
Difficulty Walking: Difficulty or inability to stand on tiptoes on the affected side, indicating weakness in the tendon.

How is Posterior Tibial Tendonitis Diagnosed?

Accurate diagnosis is essential for effective treatment of posterior tibial tendonitis. Podiatrists utilise a combination of methods to identify this condition accurately.

Physical Examination: A podiatrist will typically perform a physical exam to assess pain levels, swelling, and the functionality of the tendon, including the ability to stand on toes.
Imaging Tests: Imaging modalities like ultrasound and MRI are employed to view the extent of tendon damage and to differentiate tendonitis from other conditions like tears or ruptures.
Gait Analysis: Observing how a patient walks can help determine how the injury affects foot mechanics and may provide insights into underlying causes related to biomechanical imbalances.

Treatment Options for Posterior Tibial Tendonitis

Treatment of posterior tibial tendonitis varies based on the severity of the condition but generally starts with conservative methods, moving to more invasive procedures if necessary.

Rest and Ice: Initial treatment often involves rest to reduce strain on the tendon and icing to decrease inflammation.
Orthotic Devices: Custom orthotics can be prescribed to support the arch and reduce the load on the posterior tibial tendon, aiding in recovery.
Physical Therapy: Specific exercises designed to strengthen the surrounding muscles and maintain tendon flexibility can help restore function and prevent future injuries.
Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to manage pain and reduce swelling during the acute phase of tendonitis.
Surgical Treatment: In cases where conservative treatments fail to alleviate symptoms, surgical interventions may be necessary to repair the damaged tendon and restore function.

The Role of Orthotics in Managing Posterior Tibial Tendonitis

Orthotics are a cornerstone in the management of posterior tibial tendonitis, helping to address the biomechanical faults that often contribute to the condition.

Custom Fit: Orthotics are tailored to the specific needs of the patient’s foot structure, providing targeted support to the arch and reducing stress on the posterior tibial tendon.
Improving Foot Mechanics: By correcting improper foot alignment, orthotics can improve overall foot function and prevent additional strain on the affected tendon.
Long-Term Use: For many patients, orthotics will be a long-term solution to maintain foot health and prevent the recurrence of tendonitis, especially in those with significant biomechanical challenges.

Physical Therapy and Rehabilitation for Posterior Tibial Tendonitis

Physical therapy plays a crucial role in the rehabilitation of patients with posterior tibial tendonitis, focusing on restoring tendon health and preventing future issues.

Strengthening Exercises: Therapists will prescribe exercises that strengthen the muscles around the tibial tendon, particularly those that support the arch and foot alignment.
Flexibility Workouts: Improving the flexibility of the calf muscles and the Achilles tendon helps reduce tension on the posterior tibial tendon.
Ultrasound Therapy: This can be used to promote tissue healing and decrease inflammation in the affected area.
Gait Training: Rehabilitation may also involve training to improve walking patterns, thereby reducing stress on the injured tendon.

Preventive Measures to Avoid Posterior Tibial Tendonitis

Preventing posterior tibial tendonitis is key, especially for individuals at higher risk due to biomechanical issues or lifestyle factors.

Proper Footwear: Wearing supportive shoes that fit well and provide good arch support can prevent excessive strain on the tibial tendon.
Regular Stretching: Incorporating stretching into daily routines can maintain muscle and tendon flexibility, reducing the risk of injuries.
Weight Management: Maintaining a healthy weight minimises the stress on the feet and tendons during everyday activities and exercise.
Activity Modifications: Adjusting activity levels or modifying exercise routines to avoid overuse is crucial for those frequently engaged in high-impact sports.

When to Consult a Podiatrist for Posterior Tibial Tendonitis

Understanding when to seek professional help is vital for managing posterior tibial tendonitis effectively and avoiding long-term complications. If symptoms of pain and swelling do not improve with initial home care measures, it is important to consult a podiatrist like Manly Cove Podiatry. Noticeable changes in the shape of the foot, such as a flattening arch, require professional assessment. Furthermore, if you experience pain during everyday activities or cannot perform normal functions, a podiatrist can evaluate and recommend appropriate treatments or interventions.