The tibialis posterior tendon passes down the back of the leg, inside the ankle and under the foot. Overuse can cause injury or degeneration of the tendon where it inserts into the foot bones, which causes pain on the inside of the foot. The pain may radiate along the length of the tendon and can worsen if the foot is turned inwards or outwards.
Symptoms include pain on the inside of the foot which may radiate along the length of the tendon under the foot. A creaking sensation called crepitus can often be felt when the tendon moves. Pain may be made worse by passive eversion or resisted inversion. Passive eversion is when a therapist turns the foot outwards to stretch the tibialis posterior and resisted inversion is when the patient turns the soles of the feet inwards as the therapist resists to stress the tendon.
The tibialis posterior muscle passes down the back of the leg and under the medial malleolus, or bony bit on the inside of the ankle. It inserts on the lower inner surfaces of the navicular and cuniform bones in the midfoot and the base of the 2nd, 3rd, 4th and fifth long metatarsal bones under the foot. It is used to plantarflex the foot (going up on your toes) and to invert the foot (turning the soles of the feet inwards).
Tibialis posterior tendonitis 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.
The causes of tibialis posterior tendonitis include prolonged stretching of the foot and ankle into eversion. This may happen from speed skating, running on tight bends and biomechanical problems of the foot such as overpronation where the foot rolls in or flattens too much as it is in contact with the ground.
Treatment for posterior tibial tendonitis
What can the athlete do?
Apply ice or cold therapy to reduce pain and inflammation. Ice should not be applied directly to the skin but in a wet tea towel. Commercially available hot and cold packs are often more convenient. Cold therapy can be applied for 10 minutes every hour for the first 24 to 48 hours if the tendon is painful or inflamed. Later on, after the acute stage, heat may be more beneficial.
When pain allows, stretching exercises for the tibialis posterior and calf muscles should be done. Specific exercises for the tibialis posterior will strengthen the muscle which should help prevent future injury.
What can a sports injury professional or doctor do?
Applying electrotherapy such as ultrasound can help with pain and inflammation. A doctor may prescribe anti-inflammatory medication such as Ibuprofen in the short term to reduce inflammation, although long term they are thought to be of little benefit. Always check with a doctor before taking medication and do not take ibuprofen if you have asthma.
Cross friction sports massage techniques may be applied to the tendon and deep tissue massage to the tibialis posterior and calf muscles may help increase flexibility and condition of the muscles.
A sports injury professional can demonstrate, advise and monitor a rehabilitation program to strengthen the ankle and in particular the tibialis posterior muscle. Orthotic inserts can be prescribed and fitted if required to correct poor foot biomechanics. If the tendon is ruptured then it must be repaired surgically.