Tibialis posterior dysfunction
One of the most important tendons in the lower leg is the tibialis posterior tendon. Tendons are the connective tissues that join muscle to bone allowing movement of the joint. The tibialis posterior tendon starts in the calf and passes down behind the inside of the ankle to join onto the midfoot.
The tibialis posterior tendon is particularly important as it holds your arch up and provides support to your foot when pushing off your toes during walking.
The tendon may become inflamed (tendonitis) or torn.
Symptoms of tibialis posterior tendonitis:
• swelling around the medial ankle
• pain at the medial ankle
• decreased stability of the foot especially when on toes
• pain in the midfoot when the foot is placed under increased load eg. running
• gradual flattening of the arch resulting in flatfoot
• gradual formation of a pin on the outside of the ankle
Tibialis posterior tendonitis is often associated with excessive pronation (turning out of the foot). It is also common in sports where a lot of stretching of the tendon occurs e.g. speed skating, running on tight bends.
Occasionally rupture of the tendon may occur resulting in pain, swelling and disability.
Assessment and treatment
Your physiotherapist will be able to diagnose tibialis posterior tendonitis. Initially treatment will focus on reducing the inflammation. At this time your therapist would use electrotherapeutic modalities and soft tissue therapy i.e. deep tissue massage to the tendon itself and any soft tissue tightness e.g.)of the proximal muscle bulk as it is often tight. At this time you therapist would also advice a period of rest so the tendon is not continued to be aggravated. In severe cases a cast may be used to immobilize the ankle.
Following a reduction in swelling treatment would move onto focussing on strengthening of the tendon. This would involve both concentric (shortening) and eccentric (lengthening) exercises to strengthen the tendon. Your physiotherapist will at this time look at improving your biomechanics to prevent reoccurrence on your return to sport. A referral to a podiatrist may be required if orthotics are required to correct excessive pronation. Once the tendon is strengthened your physiotherapist will be able to help guide you to a gradual return to sport.
If the tendon is ruptured then the initial management involves surgery to repair the tendon. Surgery may also be required if conservative management of the tendonitis is unsuccessful. Following surgery your physiotherapist would be involved in restoring your ankle range of motion and strength and assisting your gradual return to sport and activity. Your specific management would depend on the surgery performed.