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Posterior Tibial Tendonopathy

(Posterior Tibial Tendonitis; Posterior Tibial Tendonosis)
  • Definition

    Tendonopathy is an injury to the tendon. It can cause pain, swelling, and limit movement. The injuries can include:
    • Tendonitis—an inflammation of the tendon
    • Tendonosis—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 tendonopathy.
    Tendonitis
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  • Causes

    Causes of posterior tibial tendonopathy include:
    • Overuse of the tendon
    • Poor blood supply to the tendon
    • Biomechanics that cause degeneration of the tendon, such as over pronation of the foot
  • Risk Factors

    Posterior tibial tendonopathy is more common in women and in people over the age of 40 years. Other factors that increase your chance of posterior tibial tendonopathy include:
    • Flat feet
    • Obesity
    • Diabetes
    • High blood pressure
    • Previous surgery or trauma
    • Local steroid injections
  • Symptoms

    Symptoms may include:
    • Pain and swelling near the arch of the foot and on the inside of the ankle
    • Pain that increases when standing on the ball of the foot or if the foot is flexed
    • Pain that increases with activity
    • Tiredness in the foot after little activity
    • Pain that becomes more disabling
    • Later in the course of the tendonopathy, a flattening of the arch of the foot and pronation
    • An inability to push off well when running
  • Diagnosis

    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:
  • Treatment

    Talk to your doctor about the best treatment plan for you. Options include:
    Supportive Care
    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 foot
    • A brace or cast
    • Custom-made orthotics
    Prescription or over-the-counter medication may be advised to reduce pain.
    Physical Therapy
    A physical therapist will assess your foot and ankle. An exercise program will be created to help recovery and to strengthen the muscles.
    Surgery
    In rare cases, surgery may be required to repair the tendon.
  • Prevention

    To reduce your chances of posterior tibialis tendonopathy, 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.
  • RESOURCES

    The American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

    OrthoInfo—American Academy of Orthopaedic Surgeons Ortho Info http://www.orthoinfo.org

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org

    Canadian Orthopaedic Foundation http://www.canorth.org

    References

    Gluck GS ,et al. Tendon disorders of the foot and ankle, part 3: the posterior tibial tendon. Am J Sports Med. 2010;38(10):2133-2144.

    Mazieres B, et al. Topical ketoprofen patch in the treatment of tendinitis: a randomized, double blind, placebo controlled study. J Rheumatol. 2005;32(8):1563-1570.

    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 9, 2015.

    Posterior tibialis tendinopathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 29, 2014. Accessed March 9, 2015.

    Tibialis posterior tendinosis and tibialis posterior tenosynovitis. Merck Manual for Health Care Professionals website. Available at: http://www.merckmanuals.com/professional/musculoskeletal%5Fand%5Fconnective%5Ftissue%5Fdisorders/foot%5Fand%5Fankle%5Fdisorders/tibialis%5Fposterior%5Ftendinosis%5Fand%5Ftibialis%5Fposterior%5Ftenosynovitis.html. Updated October 2014. Accessed March 9, 2015.

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