The term Tibialis Posterior Tendonitis includes 3 different conditions that can co-exist throughout a time period:
- Shin Splint Syndrome
- Τibial Crest Periostitis
- Τibial Stress Fracture
Patients with this condition typically experience pain in the region of the inner lower leg and ankle. In less severe cases, patients may only experience an ache or stiffness that increases with rest following activities requiring strong or repetitive contraction of the tibialis posterior muscle. These activities typically include excessive walking or running (especially uphill, on uneven surfaces or in poor footwear), jumping, hopping or change of direction activities. The pain associated with this condition may also warm up with activity in the initial stages of the condition.
As the condition progresses, patients may also experience pain during these activities affecting performance. The pain associated with this condition tends to be of gradual onset which progressively worsens over weeks to months with continuation of aggravating activities. In severe cases, the patient may be unable to continue the activity and may walk with a limp as a result of the pain. Patients with this condition may also experience pain on firmly touching the tibialis posterior tendon and sometimes on performing one or more single leg heel raises.
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 as in going up on your toes, and invert the foot which is turning the soles of the feet inwards.
Tibialis posterior tendonitis is an overuse injury and is thought to be due more often 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 posterior tibial dysfunction which results in fallen arches, or flat feet.
The causes of tibialis posterior tendonitis include prolonged stretching of the foot and ankle into eversion such as in speed skating, running on tight bends and biomechanical problems of the foot such as over-pronation 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 podiatrist do?
A podiatrist can demonstrate, advise and monitor a rehabilitation program to strengthen the ankle and in particular the tibialis posterior muscle. Specialized orthotic devises can be prescribed and fitted if required to correct poor foot biomechanics. This is achieved by using sophisticated foot scanning platforms to take the most accurate print of the foot during walking and standing.
If the tendon is ruptured then it must be repaired surgically.