Tibialis Posterior Tendinopathy
The Posterior Tibialis tendon passes down the back of the leg and under the foot. Injury or degeneration of the tendon may cause pain on the inside of the foot that may radiate along the line of the tendon.
Symptoms of Posterior Tibialis Tendonitis
- Pain on the inside of the foot that may radiate along the line of the tendon.
- Pain made worse by passive eversion (therapist turns the foot outwards) or resisted inversion (therapist resists patient turning the soles of the feet inwards).
- Crepitus (a creaking on the tendon when it moves).
What is Posterior Tibialis Tendonitis?
The tibialis posterior muscle passes down the back of the leg and under the medial malleolus (bony bit on the inside of the ankle). It inserts on the lower inner surfaces of the navicular and cuniform bones and the base of the 2nd, 3rd, 4th and fifth metatarsal bones under the foot. It is used to plantarflex the foot (as in going up on your toes) and invert the foot (turning the soles of the feet inwards).
This is an overuse injury and is thought to be due to degeneration of the tendon rather than acute inflammation. There may be a partial avulsion (where the tendon pulls away from the bone) at the attachment to the navicular bone.
Long-term injuries to the Tibialis Posterior can result in insufficiency of the muscle and a condition called Tibialis Posterior Syndrome or Dysfunction. This results in fallen arches, or flat feet.
Causes of Tibial Posterior Tendon Injury
- Prolonged stretching of the foot and ankle into eversion such as in speed skating.
- Running on tight bends.
- Over-pronation of the foot (foot flattens or rolls in when running).
Treatment for Posterior Tibial Tendonitis
What can the athlete do?
- Apply cold therapy to reduce pain.
- Stretch the muscles at the back of the lower leg - when pain allows
- See a sports injury professional.
What can a sports injury professional or doctor do?
- Apply electrotherapy such as ultrasound to help with pain.
- Prescribe anti-infammatories such as Ibuprofen
- Apply sports massage techniques to the tendon and muscle.
- Advise on posterior tibialis exercises to strengthen the muscle and tendon
- Prescribe orthotic inserts if required to correct poor foot biomechanics.
- If the tendon is ruptured then it must be repaired surgically.
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