Posterior Tibialis Tendonitis

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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.

Symptoms:
  • 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).
Causes:
  • 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
  • Apply cold therapy to reduce pain.
  • Stretch the muscles at the back of the lower leg - when pain allows
  • 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.
Physiotherapy Rehabilitation

Aims of rehabilitation:
The aims of rehabilitation of Tibialis Posterior tendinopathy can be broken down into stages:
  • Decrease initial pain and inflammation.
  • Improve mobility and flexibility.
  • Improve strength
  • Reestablish neural control and coordination.
  • Return to full fitness.
Decrease initial pain and inflammation
  • Rest - this is essential. Try to avoid any activity or movement which aggravates the condition.
  • Ice - use cold therapy throughout the rehabilitation process. Apply ice for 15 minutes every 2-3 hours initially for the first day then gradually reduce this to 3 times a day.
  • Compression - use a tube grip bandage or taping. Even better are products that specifically apply compression at the same time as cooling.
Improve mobility and flexibility
  • Perform ankle circle movements in the early stages to keep it mobile.
  • Stretching the muscles at the back of the lower leg is important.
  • Make sure you stretch the calf muscles with both the knee straight and the knee bent. This will ensure all muscles in the back of the lower leg are stretched thoroughly.
  • Perform stretching exercises 2 to 3 time a day.
  • Apply ice / cold therapy after stretching in the early stages of rehabilitation to help reduce any inflammation.
Improve strength
  • This can begin as soon as they can be performed without pain.
  • The athlete should be able to maintain fitness by swimming or cycling if pain allows.
  • To specifically strengthen the Tibialis Posterior muscle you must work the ankle into inversion (turning the sole of the foot inwards).
  • It also assists with plantar flexion (pointing the foot away) and so calf raise exercises can be useful.
Simple Strenthenging Exercises Pictures (Click on the picture to read description)

Simple Stretching Exercises Pictures (Click on the picture to read description)
 


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