Tibial tendonitis is a common condition affecting the lower leg, specifically the tendons around the ankle. Tendons are strong, rope-like connective tissues that connect muscles to bones, enabling movement and providing joint stability. Irritation or inflammation of these structures can impact daily activities and mobility.
What is Tibial Tendonitis?
Tibial tendonitis is the inflammation or irritation of the tibial tendons in the lower leg and ankle. It primarily manifests in two forms: Posterior Tibial Tendonitis (PTT) and Anterior Tibial Tendonitis (ATT).
Posterior Tibial Tendonitis affects the tendon running down the inside of the ankle and foot. This tendon originates in the calf muscle, extends behind the inner ankle bone, and attaches to bones in the arch. Its main function is supporting the arch and assisting with foot flexion and inversion.
Anterior Tibial Tendonitis involves the tendon at the front of the ankle, connecting the shin bone to the top of the foot. This tendon helps lift the foot upward (dorsiflexion) and aids in turning the foot inward. Both types involve damage to these connective tissues, leading to pain and dysfunction.
Recognizing the Symptoms
For Posterior Tibial Tendonitis, pain and tenderness are felt along the inside of the ankle and arch of the foot. This discomfort may worsen during or after activities like walking, running, or climbing stairs. Swelling along the inner ankle and weakness in the foot, especially when pushing off or standing on toes, are common. Over time, the foot’s arch may gradually flatten, leading to adult-acquired flatfoot.
In Anterior Tibial Tendonitis, symptoms are localized to the front of the ankle and shin. People experience pain, tenderness, and stiffness, exacerbated by movements like lifting the foot upward or turning it inward. Swelling and sometimes redness may be visible over the front of the ankle. Difficulty lifting the foot, which can lead to a “foot drop” or “foot slap” when walking, is another symptom.
Identifying the Causes
Overuse is a primary cause of tibial tendonitis, often resulting from activities involving repetitive strain on the foot and ankle, such as increased running, jumping, or walking. A sudden increase in physical activity intensity or duration can also overwhelm the tendons, leading to inflammation. Improper footwear that lacks adequate support or fits poorly can contribute by altering foot mechanics and increasing strain.
Muscle imbalances or tightness, particularly in the calf muscles, can place additional stress on the tibial tendons. Poor foot mechanics, such as flat feet (pronation) or unusually high arches, can alter foot alignment and movement, leading to chronic strain. Direct trauma, like an ankle sprain or a fall, may also cause acute injury. Certain pre-existing medical conditions, including obesity, hypertension, diabetes, and inflammatory connective tissue diseases like rheumatoid arthritis, are associated with an increased risk of tendon problems.
Diagnosis and Treatment Options
Diagnosis begins with a physical examination and medical history review. A healthcare provider inspects the foot and ankle for swelling, tenderness, and deformities. They may apply pressure along the tendon’s path and ask the patient to perform movements like standing on toes or walking to assess pain, range of motion, and strength. Imaging tests such as X-rays, ultrasound, or MRI scans may be ordered to confirm the diagnosis and rule out other conditions.
Treatment generally begins with conservative, non-surgical approaches. Rest, reducing aggravating activities, and applying ice can help. Over-the-counter anti-inflammatory medications may manage pain and inflammation. Physical therapy focuses on exercises to improve flexibility, strengthen ankle and foot muscles, and correct biomechanical issues. Orthotics provide arch support and redistribute pressure, reducing tendon strain. In some cases, immobilization with a walking boot or brace may be used. If conservative measures fail after several months, more invasive options like corticosteroid injections or surgery may be considered.
Preventing Future Occurrences
Preventing tibial tendonitis involves minimizing stress on the tendons and promoting foot and ankle health. Gradually increasing activity levels allows tendons to adapt to new demands, preventing sudden overload. Incorporating proper warm-up routines before exercise and cool-down stretches afterward helps prepare muscles and tendons for activity and promotes flexibility.
Wearing supportive footwear that fits well and provides adequate cushioning and arch support is important, especially during physical activities. Addressing underlying biomechanical issues, such as flat feet or excessive pronation, with orthotics or specialized footwear can significantly reduce tendon strain. Regular stretching and strengthening exercises for lower leg and foot muscles enhance stability and resilience. Listening to the body’s signals and avoiding overtraining or pushing through pain can prevent minor irritation from escalating.