Tendinopathy is an injury to the tendon. It can cause pain, swelling, and limit movement. The injuries can include: Tendonitis—an inflammation of the tendonTendinosis—tiny tears in the tendon 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, then the arch of the foot can collapse. This will make the foot pronate, or roll inward. These injuries can make it painful to walk.
Treatment depends on the severity of the tendinopathy.
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Causes of posterior tibial tendinopathy include: Overuse of the tendonPoor blood supply to the tendonBiomechanics that cause degeneration of the tendon, such as over-pronation of the foot
Posterior tibial tendinopathy is more common in women and in people over the age of 40 years. Other factors that increase your chance of posterior tibial tendinopathy include: Flat feetObesityDiabetesHigh blood pressurePrevious surgery or traumaLocal steroid injections
Symptoms may include: Pain and swelling near the arch of the foot and on the inside of the anklePain that increases when standing on the ball of the foot or if the foot is flexedPain that increases with activityTiredness in the foot after little activityPain that becomes more disablingLater in the course of the tendinopathy, a flattening of the arch of the foot and pronationAn inability to push off well when running
You will be asked about your symptoms and medical history. A physical exam will be done. It will include a foot exam. 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.
Images of your foot and ankle may be taken. This can be done with: X-raysMRI scanUltrasound
Talk to your doctor about the best treatment plan for you. Options include:
The foot and ankle will need time to heal. RICE is often the main part of treatment: Rest—Avoid activity that causes pain. Reduce shock or vibrations to the foot and ankle.Ice—Ice therapy may help relieve swelling. Compression—Compression bandages can provide gentle pressure to help move fluids out of the area. Elevation—Keeping the foot elevated can help fluids drain out or prevent fluids from building up.
To help support the foot and promote healing, you may need: A strap or tape for your footA brace or castCustom-made orthotics
Prescription or over-the-counter medication may be advised to reduce pain.
A physical therapist will assess your foot and ankle. An exercise program will be created to help recovery and to strengthen the muscles.
In rare cases, surgery may be required to repair the tendon.
To reduce your chances of posterior tibialis tendinopathy, take these steps: Avoid activities and sports that repeatedly stress the foot and ankle.Maintain proper muscle strength.Gradually increase the frequency and intensity of exercise.Wear good, supportive shoes that provide arch support.Use proper technique for sports and dance activities.
Gluck GS, et al. Tendon disorders of the foot and ankle, part 3: the posterior tibial tendon.
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Houck J, Neville C, Tome J, Flemister A. Randomized controlled trial comparing orthosis augmented by either stretching or stretching and strengthening for stage II tibialis posterior tendon dysfunction. Foot Ankle Int. 2015;36(9):1006-16.
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Posterior tibial tendon dysfunction. American Academy of Orthopaedic Surgeons Ortho Info website. Available at:
http://orthoinfo.aaos.org/topic.cfm?topic=A00166. Updated December 2011. Accessed March 11. 2016.
Tibialis posterior tendinosis and tibialis posterior tenosynovitis. Merck Manual for Health Care Professionals website. Available at:
http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/foot_and_ankle_disorders/tibialis_posterior_tendinosis_and_tibialis_posterior_tenosynovitis.html. Accessed March 11, 2016.
Last reviewed March 2016 by Laura Lei-Rivera, PT, DPT, GCS
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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